Skip to main content

Full text of "Bulletin of the University of Maryland School of Medicine 1916-1917"

See other formats 


■^tm 


"^  -■- '  * 


BULLETIN 


OF  THE 


Umversity  of  Maryland  School 
OF  Medicine 


AND 


College  of  Physicians  and 
Surgeons 


VOLUME  I 


PUBLISHED  MONTHLY  EXCEPT 

AUGnSS^SSD  SEPT EM^BR_^ 

CALVRffT  ANB^ARATOGA  STREETS 

/    .  ^BALTIMORE,  MB.  *"• 


COMPOSED  .\^"D  PRINTED  AT  THE 

WAVERLY  PRESS 

By  the  Williams  &  Wilkins  Company 

Baltimore,  Md.,  U.  S.  A. 


TABLE  OF  CONTENTS 
No.  1.    JUNE,  1916 

Our  Gracious  Despot,  The  Doctor.    By  T.  H.  Lewis,  D.D.,  LL.D 2 

Address  of  Dr.  Ridgely  B.  Warfield  in  Presenting  Testimonial  to  Dr. 

Winslow 4 

Response  of  Dr.  Randolph  Winslow  in  Accepting  Testimonial 8 

Inoperable    CSncer    of     the    Uterus — ^Percy    Cautery.     By    William    S. 

Gardner,  M.D 12 

Kidney  Insufficiency  During  Pregnancy.     By  J.  M.  H.  Rowland,  M.D., 

F.  A.  C.  S 17 

A  Report  of  Some  Unusual  Cases  of  Disease  of   the   Nasal  Accessory 

Sinuses.     By  John  R.  Winslow,  M.D 23 

Editorials: 

To  Our  Joint  Alumni  and  our  Friends  Everywhere :  Greeting 24 

The  Endowment  Fund  For  the  Pathological  Department 24 

The  Annual  Commencement 25 

News  Items 30 

Deaths 31 

No.  2.     JULY,  1916— CATALOGUE 

No.  3.     OCTOBER,  1916 

Prof.  Thomas  A.  Ashby,  M.D.,   LL.D     By  Randolph  Winslow,  A.M., 

M.D.,  LL.D 33 

Prof.  William  Simon,  Ph.D.,  M.D.,  Sc.D.,  LL.D.     By  Alexius  McGlan- 

nan,  A.M.,  M.D 36 

Further  Observations  on  the  Value  of  Scarlet  Red  in  the  Treatment  of 
Gastric  and  Duodenal  Ulcer.     By  Julius  Friedenwald,  M.D.    and  T. 

F.  Leitz,  M.D 39 

Foreign  Students  at  the  University  of  Maryland.     Caleb  Winslow,  A.M., 

Registrar 43 

Dr.  E.  B.  Friedenwald  Back  From  Border 44 

Editorials: 

The  Editor  of  the  "Bulletin." '. .  46 

The  Call  to  Arms  and  the  University 47 

The  State  Appropriations  for  1915  and  1916 .' 48 

Resignations  of  Professors  Pole  and  Nydegger 49 

The  Banquet ' 50 

Losses  in  the  Faculty 52 

Meeting  of  the  New  England  Alumni 52 

Meeting  of  the  New  York  Alumni 53 

Rescues  Young  Man 55 

iii 


IV  CONTENTS 

News  Items 66 

Deaths 61 

Book  Reviews 63 


No.  4.     NOVEMBER,  1916 

Louis  McLane  Tiffany.     By  Ridgely  B.  Warfield,  M.D 65 

Gunshot    Wounds    of    the    Intestines.     By  Randolph  Winslow,   M.D., 

LL.D 66 

Letters  of  Appreciation 71 

Strongyloides   Intestinalis.     By  Erwin   E.    Mayer,  M.D.  and  Arthur  F. 

Peterson,  M.D " 72 

Experimental  Study  of  McDonald's  Solution  as  an  Antiseptic  in  Surgical 
Technique  and  Ether  Anesthesia  Per  Rectum.     By  R.  W.  Locher, 

M.D 76 

Editorials: 

Death  of  Dr.  Louis  McLane  Tiffany 86 

The  Session  1916-1917 87 

The  Mayo  Foundation 88 

Dr.  Joseph  Irwin  France 88 

Graduates  of  the  Baltimore  Medical  College 89 

To  Explore  Upper  Amazon. 90 

Statement  of  the  Ownership,  Management,  Circulation,  Etc.,  Required  by 

the  Act  of  Congress  of  August  24,  1912 90 

News  Items 91 

Deaths 92 

Book  Reviews 93 


No.  5.     DECEMBER,  1916 

Address  by  Dr.  Ridgely  B.  Warfield.     Academic  Day,  University  of  Mary- 
land, November  14,  1916 97 

The    Prophylaxis   and   Treatment    of    Tetanus.     By  Alexius  McGlan- 

nan,  M.D 106 

The  Role  of  Certain  Diphtheroid  Microorganisms.     By  Charles  C.  W. 

Judd,  A.B.,  M.D 113 

Editorials: 

Death  of  Miss  Louisa  Parsons — A  Nightingale  Nurse 120 

National  Board  of  Medical  Examiners 121 

David  Street  Memorial  Scholarship 122 

News  Items 123 

Deaths 126 

Book  Reviews 127 


CONTENTS  V 
No.  6.     JANUARY,  1917 

Thomas  Bartholin  1616-1916.     By  Ejnar  Hansen,  M.D 129 

Why  the  Limitations?     By  William  J.  Todd,  M.D 131 

Report  of  Two  Interesting  Cases  of   Myxedema  in   the    Same   Family. 

By  Dr.  E.  F.  Raphel 135 

Abstract  of  the  Report  of  Ruth  Lee  Briscoe,  Librarian  of  the  University 

of  Maryland  Medical  School 139 

Correspondence * 140 

Editorials: 

Happy  New  Year 143 

Medical  Preparedness 144 

The  Library  of  the  University  of  Maryland 145 

With  the  Regulars  in  Mexico 146 

A  Soldier  or  Sailor  no  Better  Than  His  Teeth 148 

Final  Financial  Statement  of  the  Journal  of  the  College  of  Physicians 

and  Surgeons  Alumni  Association 150 

Births 150 

Marriages 150 

News  Items 151 

Deaths 156 

Book  Reviews 158 


No.  7.    FEBRUARY,  1917 

John  Wesley  Chambers,     By  Harry  Friedenwald 161 

Presidential  Address.     By  Dr.  J.  Carroll  Monmonier 164 

Affections  of  the  Submaxillary  Salivary  Gland.     By  Randolph  Wins- 
low,  M.D 167 

Perforated  Gastric  Ulcer  and  Duidenal  Ulcer  with   Report  of   a   Case. 

By  Richard  Shea,  M.D 169 

Hospital  Noises.     By  Erwin  E.  Mayer,  M.D 173 

The  Chambers  Memorial  Fund .' 176 

Correspondence 179 

Resolutions  on  Death  of  Dr.  Harry  W.  Stoner 180 

Editorials : 

Death  of  Professor  John  Wesley  Chambers,  M.D.,  Sc.D 181 

Death  of  Professor  Pearce  Kintzing,  M.D 182 

Is  Cancer  Either  Contagious  or  Hereditary? 182 

Hereditability  of  Cancer 183 

Death  of  Dr.  Harry  Wilbur  Stoner 184 

Deaths 185 

News  Items 188 

Marriages 190 


VI  CONTENTS 

No.  8.     MARCH,  1917 

Preparing  for  Preparedness.     By  S.  J.  Fort,  M.D 191 

Some  Observations  on  the  Care  of   the   Feeble  Minded   in   Maryland. 

By  Charles  G.  Hill,  A.M.,  M.D 194 

Acidosis.     By  W.  H.  Smith,  M.D.,  and  Arthur  M.  Shipley,  M.D 197 

Blood  Transfusion  in  Extrauterine  Gestation.     By  Hugh  Brent,  M.D., 

F.A.C.S 206 

Delirium  Tremens  as  a  Complication  of  Surgical  Lesions,  Some  Exper- 
iences   with    a    Simple    Method    for  its  Prevention  and  Cure.     By 

Ignatius  P.  A.  Byrne,  M.D 209 

The  Chambers  Memorial  Fund 214 

Hospital  Appointments. . : 214 

The  Baltimore  Medical  College  Alumni  Certificate 215 

Correspondence 217 

Editorials: 

The  Campaign  for  the  Maryland  General  Hospital 218 

The  Endowment  Fund  of  the  University  of  Maryland 218 

Death  of  Dr.  Elmer  Newcomer 219 

Deaths 220 

News  Items 221 

No.  9.    APRIL,  1917 

Tribute  to  Dr.  Lockwood.     By  Dr.  Harry  Friedenwald 223 

Epidemic  Cerebro-Spinal  Meningitis.     By  Erwin  E.  Mayer,  M.D 225 

Sexual  Impotence.     By  Herbert  Schoenrich,  M.D. 233 

The  Allen  Treatment  of  Diabetes.     By  Theodore  H.  Morrison,  M.D 248 

The  Chambers  Memorial  Fund 248 

'Statement  of  the  Owership,  Management,  Circulation,   Etc.,  Required 

by  the  Act  of  Congress  of  August  24,  1912 252 

Editorials : 

The  Call  to  War 253 

No.  10.    MAY  1917 

Birth  Injuries  of  the  Shoulder.     By  Astley  P.  Ashhurst,  M.D 255 

The  Surgical  Treatment  of  Gastric  and  Duodenal  Ulcers.     By  J.  G.  Skil- 

ling,  Senior  Medical  Student,  1917 258 

Presentation  of  a  Portrait  of  Dr.  John  W.  Chambers  to  the  Medical  and 

Chirurgical  Faculty  of  Maryland  by  Alexius  McGlannan,  M.D 265 

Acceptance  of  the  Portrait  of  Dr.  Chambers  by  Randolph  Winslow,  M.D. .    266 

Chambers  Memorial  Fund 267 

Report  of  Charles  Markell,  Treasurer 267 

Correspondence 272 


CONTENTS  Vil 

Editorials: 

An  Interesting  Bit  of  History .- 275 

Notes  from  the  Mexican  Border 277 

Advisability  of  Continuous  Sessions  of  Medical  Schools  During  War  278 
Recipients  of  Certificates  to  Graduates  of  the  Baltimore  Medical  College  280 

New  Items 280 

Deaths. 285 


Q 


fJO 


PROFESSOR  RANDOLPH  WINSLOW 


BULLETIN 


OF  THE 


University  of  Maryland  School 
OF  Medicine 

AND 

College  of  Physicians  and 
Surgeons 

Successor  to  The  HospiTai,  Bulletin,  of  the  University  of  Maryland, 
Baltimore  Medical  College  News,  and  the  Journal  of  the  Alumni  Asso- 
ciation of  the  College  of  Physicians  and  Surgeons 


Vol.  I 


JUNE,  1916 


No.  1 


□  DC 


MiiiMiiiiiiiiii.inin 


Mumm^Mm 


mmc 


SSQCIEMM 


"II iiiiiHiiiMiniiMiniiiiiiii.iiiiiir.iiiiiiima 


MANY  have  labored  earnestly  for  the  interests  of  the  University  of  Mary- 
land, but  none  has  wrought  more  mightily  than  i^anbolp!)  HtnslobJ. 
Its  interests  have  been  his  interest.  His  has  been  a  labor  of  love. 
Unselfishly  he  has  given  without  stint,  time  and  money,  thereby  hoping  to 
realize  a  larger  and  broader  University.  Graduating  with  the  class  of  1873, 
practically  ever  since  he  has  in  some  capacity  or  other  been  associated  with 
the  teaching  force,  the  last  twenty-five  years  of  which  have  been  spent  as  a 
member  of  the  Major  Faculty  and  Board  of  Regents.  At  all  times  a  pro- 
gressive, with  the  advance  of  years  he  has  not  been  a  laggard  but  wide-awake 
to  the  possibilities  attendant  the  adoption  of  modern  ideas  in  medical  educa- 
tion. It  was  mainly  through  his  efforts  that  the  new  University  Hospital  was 
built,  that  the  curriculum  was  advanced  from  two  to  three,  then  later  to  four 
years,  and  the  adoption  of  the  premedical  requirements,  and  the  consumma- 
tion of  the  various  mergers.  Though  past  60,  he  is  fortunately  in  full  pos- 
session of  a  virile  body  and  mind,  and  still  takes  an  active  interest  in  crea- 
ting and  determining  the  policies  of  the  institution.  For  more  than  forty 
years  during  stress  and  strain  he  has  ever  turned  his  face  toward  the  morning, 
never  the  setting  sun.  His  has  been  a  large  part  in  the  shifting  scenes  of  the 
past  two  and  a  half  decades.  In  recognition  of  a  work  well  done,  it  is  our 
pleasure  as  well  as  pleasant  duty  to  inscribe  this,  the  initial  number  of  the 
Bulletin,  to  aaanbofpf)  WinsloVu.  A.M.,  M.D.,  LL.D.,  Professor  of  Sur- 
gery in  the  University  of  Maryland,  a  skillful  and  dexterous  operator,  a  gifted 
teacher  and  a  man  unafraid  to  fight  unswervingly  for  what  he  considers  right, 
than  whom  none  is  more  worthy  of  the  honor. 


DBD 


mmmmEmimmMmsEssimu 


ffoini,iiiiiii:ii„tiiii,ii,uiiii,fliiini,iiii,i 


nine 


B 
ZIQB 


OUR  GRACIOUS  DESPOT,  THE  DOCTORS 
By  T.  H.  Lewis,  D.D.,  LL.D. 

The  sentiment  to  which  I  have  been  appointed  to  respond  may 
appear  rather  ungracious,  I  fear,  to  this  distinguished  company.  So 
I  will  begin  my  treatment  with  an  emollient.  The  word  "despot," 
although  so  disagreeable  to  our  republican  ears,  is  perfectly  harm- 
less, meaning  only  to  rule  without  a  constitution.  And  as  the  doc- 
tor is  usually  called  in  after  the  constitution  is  gone,  we  naturally  call 
him  a  despot. 

Then,  too,  the  association  of  the  two  words  is  quite  respectable  and 
ancient.  One  of  the  famous  wise  men  of  antiquit}^,  whose  writings 
are  still  read  in  some  of  our  churches,  says,  "He  that  sinneth  before 
his  Maker,  let  him  fall  into  the  hand  of  the  phj^sician."  This  is 
slightly  ambiguous,  for  it  is  not  certain  whether  it  is  meant  as  a 
prescription  or  a  sentence.  But  in  either  case  the  idea  remains 
that  the  doctor  is  a  sort  of  deputy  of  the  Almighty  to  deal  with 
sinners.  And  as  all  of  us,  miserable  sinners  that  we  are,  do  fall  into 
the  hand  of  the  physician,  sometimes  for  healing  and  sometimes  for 
punishment,  it  is  not  strange  that  we  should  regard  him  and  name  him 
with  more  than  common  reverence.  The  large  powers  he  exercises 
and  the  finahty  of  his  judgments  suggest  the  despot;  while  the  be- 
nevolent intention  in  the  use  of  those  powers  in  alleviating  human 
misery  entitles  him  to  the  qualifying  word  "Gracious." 

I  have  often  admired  the  ease  with  which  the  haughty  and  arro- 
gant spirit  is  brought  down  to  submissiveness  by  this  despot, 
whose  only  weapon  is  a  prescription.  Some  one  remarked  in  Presi- 
dent Grant's  presence  once  that  Charles  Sumner  didn't  believe  in  the 
Bible.  "That's  because  he  didn't  write  it,"  retorted  Grant.  Sum- 
ner might  treat  the  Almighty  with  that  scant  courtes}',  but  he  be- 
lieved in  his  doctor's  scripture,  even  if  he  didn't  write  it  and  couldn't 
read  it.  So  do  we  all.  0,  I  know  we  parade  our  small  cjaiicisms 
about  your  aqua  pura  and  your  chalk  powders  and  your  bread  pills; 
but  that  is  when  we  are  indulging  in  a  spree  of  riotous  health.  When 
pain  comes  into  our  midst,  however,  or  when  the  dark  shadow  lurks 
about  our  thresholds  and  threatens  our  peace,  all  our  levity  vanishes. 
We  meekly  take  the  mystic  scroll  as  if  it  were  the  oracle  of  fire- 

^  Toast  at  the  testimonial  dinner  given  to  Dr.  Randolph  Winslow  at  the 
Hotel  Belvedere,  May  8,  1916. 

2 


OUR  GRACIOUS  DESPOT,  THE  DOCTOR  3 

touched  lips,  and  hie  us  down  to  the  apothecary  to  pour  out  sub- 
missively our  pint  of  coin  for  the  drachm  of  promised  heahng.  Gra- 
cious despot,  if  it  works;  despot  still,  whether  it  works  or  not. 

And  there  is  the  love  of  money,  which  Holy  Writ  warns  us  against 
so  often  and  so  ineffectively.  Does  our  gracious  despot  write  scrip- 
ture to  warn  us  against  this  insidious  foe?  He  does  not.  He 
simply  takes  it  away  from  us.  He  doesn't  take  it  because  he 
wants  it  himself,  for  few  doctors  are  rich.  What  he  does  with  it  is 
nobody's  business.  He  takes  it  from  us  for  our  good.  In  pursuit 
of  this  benevolent  purpose  he  does  not  figure  his  bill  on  the  basis 
of  how  much  the  treatment  costs,  but  on  how  much  the  patient  has 
got;  for  the  patient  must  be  saved  at  all  hazards. 

And  who  but  a  despot  could  put  a  man  on  a  diet?  The  only 
difference  between  "die"  and  "diet"  is  the  addition  of  weak  "t."  It 
seems  to  be  the  favorite  strategy  of  the  doctor  to  open  his  attacks 
with  a  blockade  of  the  interior.  He  invariably  begins  the  treatment 
of  a  case  he  does  not  understand  with  the  prescription,  "Of  all  the 
trees  of  the  garden  which  you  don't  like  you  may  freely  eat."  How 
could  he  get  away  with  this  so  uniformly  if  he  were  not  a  despot? 
They  all  do  it.  Moses  was  the  first  dietitian,  and  he  always  pref- 
aced his  regimen  with,  "Thus  saith  the  Lord." 

But  there  is  that  in  the  relation  of  the  patient  to  the  doctor  that 
nothing  but  the  word  gracious  can  adequately  describe.  For  what 
relation  in  this  world  is  so  like  the  rightful  attitude  ot  man  to  his 
Maker  as  the  patient's  faith  in  his  doctor?  We  obey  you  implicitly — 
at  least  when  we  are  sick.  We  close  our  shop,  break  up  our  program 
of  business  or  pleasure,  and  go  where  you  send  us! — if  we  have 
money  enough.  We  go  to  bed  and  rise  up  again;  we  eat  and  re- 
frain from  eating  at  your  command.  No  drug  is  so  bitter  we  will  not 
take  it,  no  knife  so  keen  we  will  not  submit  to  it,  no  convalescence 
so  tedious  we  will  not  endure  it  if  our  doctor  press  it  on  us.  For  we 
believe  in  you.  Bereft  of  every  human  succor  save  yours,  we  lie 
outstretched  before  you  mutely  appealing.  Knowledge  has  spoken 
its  last  word,  skill  has  performed  its  final  miracle,  and  still  the  tide  of 
death  surges  in  and  the  awful  mystery  which  no  scalpel  will  reveal 
awaits  solution.  How  is  it  that  at  such  a  time  you  can  call  us  back 
to  life?  You  call  us  by  faith.  Our  closing  ears  are  pierced  by  the 
good  cheer  ringing  in  your  voice;  the  gleam  of  hope  from  your  eye 
darts  through  the  gloom  gathering  about  us,  and  the  ebbing  tide  of 
life  leaps  up  again  at  your  call.     Faith  answers  to  faith;  hope  beats 


4  RroOELY   B.    WARFIELD 

its  way  back  responsive  to  the  throb  of  your  sympathy;  and  there 
you  stand  before  us  the  human  embodiment  of  the  resurrection  and 
the  hfe,  because  "all  things  are  possible  to  him  that  believeth." 
Our  gracious  Despot,  permit  me,  in  sign  of  our  unswerving  allegiance, 
to  kiss  your  skillful,  beneficent  hand! 

ADDRESS  OF  DR.  RIDGELY  B.  WARFIELD  IN  PRESENT- 
ING TESTIMONIAL  TO  DR.   WINSLOW 

The  Mayflower  pioneer,  Edward  Winslow,  notable  governor  of 
Plymouth,  and  his  three  brothers,  John,  Kenelm  and  Josiah,  all 
identified  with  the  early  history  of  the  colony,  were  ancestors  of  a 
numerous  family  now  widely  scattered  throughout  the  country. 
Somewhat  obscured  is  the  evidence  of  direct  descent  from  these 
pilgrim  fathers  of  the  branch  of  the  family  in  North  Carolina,  but 
the  tradition  is  doubtless  true,  and  as  early  as  1677  a  new  England 
trader,  Joseph  Winslow,  was  abeady  established  there  and  exer- 
cised his  full  privileges  of  citizenship,  being  recorded  as  serving  as 
foreman  on  a  jury  and  as  bringing  indictment  against  the  then 
acting  governor  of  Albemarle  colony.  From  this  beginning  in  the 
old  North  state  the  Winslows  in  all  succeeding  years  have  been  ac- 
tive participants  in  affairs  of  both  local  and  national  importance. 

The  subject  of  our  testimonial,  Dr.  Randolph  Winslow,  was  born 
in  the  village  of  Hertford,  near  Albemarle  Sound,  on  October  23, 
1852. 

Here  he  lived  as  a  boy  and  here  his  primary  education  was  ob- 
tained, irregular^  and  with  much  time  lost  during  the  years  of  the 
Civil  War.  Because  of  the  desertion  of  the  negroes,  he  had  to 
take  part  in  household  and  other  work,  but  he  drilled  too  with 
volunteers  and  with  the  boys'  company  of  Hertford  Zouaves  and 
otherwise  took  hvely  boyish  interest  in  the  struggles  of  the  Con- 
federacy. 

Commodity  of  every  kind  was  restricted  at  that  time  in  his  com- 
munity, yet  he  recalls  that  he  had  good  clothes  of  fine  blue  cloth 
made  from  the  discarded  garments  of  his  elders.  These,  however, 
he  could  seldom  wear,  because  the  color  was  not  then  popular  in  the 
South. 

His  father,  Dr.  Caleb  Winslow,  was  a  successful  physician  of 
wide  reputation.  He  was  an  excellent  surgeon  and  held  for  a  time 
a  world's  record  of  ninety-nine  hthotomies  with  one  death. 


ADDRESS    IN   PRESENTING   TESTIMONIAL  5 

At  the  end  of  the  war  he  came  to  Baltimore,  following  his  brother, 
Dr.  John  R.  Winslow,  who  was  also  a  prominent  medical  practitioner. 

The  brothers  both  became  quickly  identified  with  Maryland  medi- 
cine and  were  important  members  of  that  choice  emigration  from  the 
South  in  the  sixties  which  so  strongly  influenced  medical  practice 
and  teaching  in  Baltimore  in  the  last  third  of  the  nineteenth  century. 

Dr.  Caleb  Winslow's  father  was  Nathan  and  his  mother  was 
born  Margaret  FitzRandolph.  He  married  Jane  Paxson  Parry,  a 
daughter  of  Oliver  and  Rachel  Randolph  Parry  and  a  granddaughter 
of  Capt.  Edward  FitzRandolph,  an  officer  of  the  4th  Penna.  Regi- 
ment in  the  Continental  Army.  Dr.  Winslow  is  thus  doubly  de- 
scended from  the  distinguished  FitzRandolph  family.  Becoming 
a  "Quaker,"  Capt.  Edward  FitzRandolph  so  far  as  possible  eschewed 
his  title  and  dropped  the  prefix  "Fitz."  He  bore  the  scars  of  con- 
flict, however,  and  for  many  years  a  highly  respected  "Friend" 
sat  at  the  top  of  the  Arch  Street  Meeting.  The  story  is  told  of 
how  on  one  occasion  a  bystander  commented  spitefully  in  his  hear- 
ing on  the  profound  respect  accorded  him  with  "What  has  he,  a 
Quaker,  done  for  his  country?"  The  old  gentleman  paused  in  his 
walk  and  quickly  retorted,  "Friend,  at  least  I  was  where  thee 
would  not  have  dared  show  thy  naked  nose." 

A  son  of  the  captain  was  Dr.  Jacob  Randolph  of  Philadelphia,  a 
prominent  medical  teacher  and  writer  who  married  a  daughter  of 
Dr.  Philip  Syng  Physick.  A  grandson  was  the  late  Genl.  Wallace 
F.  Randolph,  chief  of  artillery  in  the  United  States  Army. 

Somewhere  in  the  early  American  development  of  the  Society  of 
Friends  and  perhaps  as  a  direct  result  of  the  historic  pilgrimage  in 
1671  of  its  founder,  George  Fox,  through  the  then  wilderness  of 
North  Carolina,  the  Winslows  were  enrolled  as  members  and  the 
family  to  this  day,  with  wide  connections,  are  "Quakers." 

Dr.  Winslow  is  fortunate  in  his  heritage.  Still  honor  attends  not 
condition,  but  rather  service,  on  the  plain  if  difficult  performance 
of  doing  one's  best  and  life  for  him  has  been  both  full  and  fruitful. 

On  coming  to  Baltimore  in  1865  he  entered  Rugby  Academy. 
After  two  years  he  went  to  Haverford  College  where  he  graduated 
with  the  degree  of  A.B.  in  1871.  He  graduated  in  medicine  at  the 
University  of  Maryland  in  1873  in  his  twenty-first  year.  Then 
followed  post  graduate  work  at  the  University  of  Pennsylvania 
and  in  Philadelphia  hospitals  and  a  course  in  clinical  microscopy  un- 
der the  late  Dr.  Joseph  Richardson.     In  1874  he  was  given  his  de- 


6  RID  GEL  Y   B.    WARFIELD 

gree  of  M.A.  by  Haverford,  not  in  the  usual  course  by  thesis  pres- 
entation, but  following  examination  after  special  study  in  advanced 
Greek. 

Returning  to  Baltimore  he  became  connected  with  his  Alma 
Mater  as  prosector  to  the  professor  of  anatomy,  Dr.  Francis  T. 
Miles,  and  in  the  next  year  was  associated  with  Dr.  J.  Edwin 
Michael  as  assistant  demonstrator  of  anatomy.  This  position  he 
held  for  six  years  and  there  was  thus  inaugurated  a  devoted  service 
to  the  University  which  has  been  maintained  without  interval  for 
more  than  forty  years. 

From  1880  to  1886  he  was  demonstrator  of  anatomy  and  until 
1891  lecturer  on  clinical  surgery.  He  succeeded  Dr.  Michael  as 
professor  of  anatomy  in.  1891,  becoming  thereby  a  member  of  the 
major  faculty  and  of  the  Board  of  Regents. 

In  1902,  on  the  resignation  of  Dr.  Tiffany,  Dr.  Winslow  became 
professor  of  surgery,  which  position  he  now  holds.  He  held  serv- 
ice at  Bay  View  from  1884  to  1891  and  also  in  1884  joined  the 
faculty  of  The  Baltimore  Policlinic.  He  was  professor  of  surgery 
at  the  Woman's  Medical  College  from  1882  to  1893  and  of  this  in- 
stitution he  was  a  founder.  In  1883  he  spent  a  half  year  in  Europe, 
for  the  most  part  in  the  University  and  clinics  of  Vienna.  Here 
he  took  course  instruction  from  men  afterwards  famous,  Lorenz, 
Woelfler  and  von  Hacker.  From  the  Billroth  clinic  he  brought 
back  latest  methods  of  surgical  technique  and  samples  of  appliances 
in  use  there  and  made  early  attempt  in  Baltimore  toward  the  intro- 
duction of  surgical  antisepsis. 

Dr.  Winslow  has  had  a  large  and  broad  experience  as  practitioner 
and  operator  and  many  of  his  cases  have  been  made  the  subject  of 
report.  He  is  a  prolific  contributor  to  current  medical  literature, 
he  writes  easily  and  pleasantly  with  peculiarly  clear  diction. 

In  1885  he  performed  pyloric  resection,  the  second  operation  of 
the  sort  in  the  country.  He  did  the  first  vaginal  hysterectomy  in 
Baltimore,  and  the  first  Alexander's  operation  of  shortening  the 
uterine  round  ligaments.  He  was  probably,  in  this  community,  the 
first  to  recognize  pus  tubes  and  to  operate  successfully  for  their  re- 
moval. He  has  made  a  number  of  interesting  reports  in  the  field  of 
gunshot  and  stab  wounds  of  the  abdomen  and  was  the  first  in  Mary- 
land to  suture  successfully  gunshot  wounds  of  the  intestine.  He 
has  reported  on  acute  intestinal  obstruction  and  records  probably 
the  first  cure  following  operation  in  Baltimore.     He  has  given  special 


ADDRESS    IN   PRESENTING   TESTIMONIAL  7 

attention  to  surgery  of  the  thyroid  and  is  one  of  the  early  operators 
for  goitre. 

This  summary  which  is  only  suggestive  of  his  operative  accom- 
plishments might  be  easily  extended. 

He  operates  easily  and  directly  with  admirable  judgment  and 
skill. 

Dr.  Winslow  is  exact  and  constant  in  his  attendance  at  meetings 
of  medical  societies,  and  doubtless  derives  recreation  from  such 
association  with  his  fellows.  Of  the  local  organizations  he  has  been 
president  of  the  old  clinical  society  and  of  the  Baltimore  Medical 
Association.  He  was  vice-president  of  the  Medical  and  Chirurgical 
Faculty  of  Maryland  in  1897  and  its  president  in  1914.  He  is  a  fel- 
low of  the  American  Surgical  Association,  of  the  Southern  Surgical 
and  Gynecological  Association  and  of  the  American  College  of  Sur- 
geons. He  is  a  member  of  the  Judicial  Council  of  the  American 
Medical  Association  and  he  arranges  to  attend  and  take  part  in,  the 
annual  meeting  of  this  great  organization  wherever  held. 

He  has  traveled  widely,  especially  in  recent  years,  and  in  con- 
nection with  national  or  international  medical  congresses.  Of  a 
number  of  such  experiences  he  has  published  agreeable  comments  of 
place  and  people. 

In  medical  debate  as  in  didactic  teaching  with  natural  talent 
ripened  by  years  of  practice,  he  talks  directly  and  clearly  with 
fluency  and  force. 

Because  of  his  enthusiastic  interest  in  a  broad  way  in  advancing 
medical  education,  he  has  been  for  twenty  years  in  a  service  just 
now  terminated,  a  valued  member  of  the  Executive  Council  of  the 
Association  of  American  Medical  Colleges.  It  is  in  this  direction, 
this  devotion  to  adequate  medical  education,  that  Dr.  Winslow 
deserves  highest  praise.  In  this  remarkable  recent  advance  in  edu- 
cational requirement,  incessantly  pursued  and  at  great  cost  to  un- 
endowed institutions  such  as  the  University  of  Maryland,  he  has 
steadfastly  stood  for  every  reasonable  progress.  He  believes  in  real 
scholarship  and  is  a  foe  to  sham  and  pretense  of  every  sort.  No 
half-way  measure  contents  him  and  he  is  no  disciple  of  expediency. 
A  follower  of  the  faith  of  his  fathers,  he  is  nevertheless  not  unmili- 
tant.  No  man  can  doubt  where  he  stands  on  any  important  question 
and  his  stand  is  as  he  sees  it  righteous  and  as  we  see  it  with  what- 
ever difference  of  opinion,  courageous  and  unmistakably  honest. 
As  a  teacher  his  chief  concern  is  in  an  intimate  personal  way  to  give 


8  RANDOLPH    WINSLOW 

faithful,  competent  instruction  and  he  requires  of  the  student  genuine 
appUcation  and  diligent  work. 

Throughout  his  life  he  has  been  blessed  with  exceptionally  good 
health,  even  casual  illness  is  almost  unknown  to  him.  In  his  col- 
lege career  he  was  an  athlete,  especially  active  in  cricket,  and  among 
the  small  group  of  men  in  Baltimore  devoted  to  this  diversion  he  was 
for  years  a  conspicuous  participant. 

A  cheerful,  tireless  worker,  devoted  to  his  profession.  Dr.  Wins- 
low  enjoys  life  simply  and  sanely,  entirely  without  ostentation.  His 
delight  is  in  his  home. 

He  married,  when  twenty-five,  Miss  Rebecca  Fayssoux  Leiper  and 
of  this  very  fortunate  union  there  have  been  thirteen  children, 
twelve  of  whom  survive. 

Younger  than  his  years,  with  ripened  wisdom,  with  undiminished 
zeal  and  capacity  and  with  the  consciousness  of  more  than  usual 
achievement.  Dr.  Winslow  may  reasonably  look  forward  with  serene 
confidence  to  an  extended  period  of  useful,  contented  life. 

RESPONSE  OF  DR.  RANDOLPH  WINSLOW  IN  ACCEPTING 

TESTIMONIAL 

By  nature  not  gifted  in  speech  my  lagging  tongue  fails  to  find 
words  with  which  to  express  in  suitable  manner  my  profound  thanks 
for  this  magnificent  testimonial  of  your  esteem  and  affection. 
From  the  inmost  recesses  of  my  heart  I  thank  you;  and  yet,  it  is 
with  no  little  embarrassment  that  I  accept  this  token  of  your  good 
will,  as  I  am  fully  conscious  of  my  own  unworthiness  of  such  an 
honor. 

There  are  epochs  in  the  lives  of  individuals  as  well  as  in  those 
of  nations.  This  is  a  great  epoch  in  my  life.  It  is  the  culmina- 
tion of  a  quarter  of  a  century  of  active  work  as  a  regent  and  pro- 
fessor in  the  University  of  Maryland,  and  it  is  a  reminder  that  my 
work  day  is  nearly  at  an  end.  While,  therefore,  I  accept  this  tes- 
timonial as,  in  some  measure,  a  token  of  personal  regard,  I  imagine 
it  to  be  also  an  evidence  of  appreciation  of  the  efforts  I  have  made 
during  the  past  twenty-five  years  in  the  upbuilding  of  the  Univer- 
sity of  Maryland.  My  whole  adult  life  has  been  spent  in  the  serv- 
ice of  the  University  in  some  capacity.  I  entered  as  a  student  in 
1871  and,  after  filling  various  subordinate  positions,  was  elected 
professor  of  anatomy  and  clinical  surgery  in  1891.     After  twenty- 


RESPONSE    IN    ACCEPTING    TESTIMONIAL  9 

five  years  of  service  I  find  myself  the  senior  member  of  the  Board 
of  Regents  and  of  the  Faculty  of  Physic.  With  but  a  single  excep- 
tion all  those  who  were  my  colleagues  in  1891  have  joined  the  great 
majority  and  their  names  and  deeds  have  become  mere  tradition  to 
most  of  the  younger  members  of  the  profession..  Some  of  these 
were  my  personal  friends  and  all  were  my  honored  colleagues,  and  it 
is  with  a  sense  of  sorrow  and  of  loss  that  I  note  their  absence  at 
this  time.  They  were  magnificent  men  and  I  feel  like  exclaiming, 
"There  were  giants  in  those  days."  On  this,  the  crowning  event  in 
my  professional  life,  I  pause  to  pay  this  tribute  of  respect  to  the 
memory  of  my  departed  colleagues  of  the  Faculty  of  1891.  Medical 
education  was  at  a  low  ebb  at  that  time,  though  there  were  indications 
of  that  renaissance  which  soon  sprang  into  existence,  and  which  has 
continued  to  the  present  time.  No  educational  requirements  were 
considered  necessary  for  students  who  sought  entrance  into  a  medi- 
cal school,  and  consequently  many  very  crude  and  unprepared  per- 
sons entered  upon  the  study  of  medicine  and,  after  two  courses  of  six 
months  each,  received  their  diplomas  and  were  turned  loose  on  the 
public.  It  is  remarkable  that  so  many  good  physicians  were  devel- 
oped under  such  conditions.  The  Baltimore  schools  have  been 
accused  of  having  been  of  low  grade  and  nonprogressive,  but  the  re- 
naissance of  which  I  have  spoken  began  right  here.  The  call  for  a 
conference  of  the  medical  schools  of  this  country  was  issued  by  the 
schools  that  now  form  the  medical  department  of  the  University  of 
Maryland,  and  resulted  in  the  formation  of  the  Association  of  Ameri- 
can Medical  Colleges.  In  1892  three  years  were  required  for  gradua- 
tion, and  in  1895  four  years,  but  the  pre-medical  educational  re- 
quirements were  practically  nothing.  The  science  of  medicine, 
however,  progressed  so  rapidly  that  it  became  evident  that  those  who 
could  profit  by  a  reasonably  well  conducted  medical  course  must  have 
a  more  liberal  education  than  had  been  previously  considered  neces- 
sary, and  in  1903  graduation  from  a  four  year  high  school  was  de- 
manded of  those  entering  medical  colleges,  that  were  members 
of  the  association.  In  1914  a  year  of  college  work  in  chemistry, 
physics  and  biology  and  either  French  or  German,  in  addition  to 
the  high  school  work,  was  required;  and  in  1918  two  years  of  col- 
lege work  is  to  go  into  effect. 

There  has  thus  been  a  complete  revolution  in  medical  education  in 
the  quarter  of  a  century  during  which  I  have  been  occupying  a  pro- 
fessorial chair  in  the  University  of  Maryland.     Many  agencies  have 


10  RANDOLPH    WINSLOW 

contributed  to  this  result;  the  Association  of  American  Medical  Col- 
leges, the  Council  of  Medical  Education  of  the  American  Medical 
Association,  the  establishment  of  state  examining  boards,  and  the  for- 
mation of  medical  departments  in  the  various  independant  endowed 
universities,  as  Johns  Hopkins,  Harvard  and  Columbia,  or  in  the 
great  state  universities  as  Michigan,  Minnesota  and  California. 
For  twenty  years  I  was  a  member  of  the  Council  of  the  Association 
of  American  Medical  Colleges  and  it  is  a  great  satisfaction  to  me  to 
have  played  a  small  part  in  this  interesting  drama.  This  revolu- 
tion, like  those  of  a  political  nature,  has  not  been  without  loss  and 
destruction.  It  has  been  attended  with  much  personal  sacrifice  on 
the  part  of  many  members  of  the  profession,  which,  for  the  most 
part,  has  been  borne  in  a  spirit  of  altruism  and  of  optimism;  while 
many  institutions,  not  all  of  them  unworthy,  have  been  compelled  to 
close  their  doors.  What  is  to  be  the  limit  of  this  advance  in  the 
requirements  for  the  study  of  medicine?  With  two  years  of  college 
work  as  a  minimum  requirement  I  think  the  limit  has  been  reached. 
While  it  is  perfectly  proper  for  certain  favored  institutions  to  make 
their  requirements  as  high  as  the,y  please,  it  is  neither  democratic 
nor  politic  to  demand  that  all  other  schools  should  do  the  same. 
Medicine  should  be  a  democracy,  not  an  aristocracy,  and  only  such 
an  amount  of  preliminary  training  should  be  required  as  will  be 
sufficient  for  the  candidate  to  fully  comprehend,  and  profit  by,  the 
instruction  given.  Of  course  there  will  be  improvements  in  various 
directions,  but  the  length  of  time,  already  burdensome,  should  not 
be  farther  extended. 

We  have  in  this  city  one  of  the  greatest  medical  schools  in  the 
world,  and  I,  like  other  citizens,  am  proud  that  we  are  so  favored. 
It  is  no  small  compliment  to  me  personally  and  to  the  institution 
with  which  I  am  identified,  that  so  many  of  the  eminent  members  of 
the  Faculty  of  the  Johns  Hopkins  Medical  School  have  honored  us  by 
their  subscription  to  this  testimonial.  I  esteem  it  a  high  honor  that 
Professor  Welch  has  favored  us  with  his  presence  and  has  edified  us 
with  his  discourse.  I  was  a  member  of  his  first  class  in  pathology 
in  1886-1887,  and  although  a  dullard  I  consider  it  a  distinction  to 
have  done  some  work  under  his  instruction.  The  Johns  Hopkins 
and  the  University  of  Maryland  are  not  competitors.  Each  has  its 
own  problems  to  solve  and  its  own  field  of  usefulness.  In  its  own 
way  each  is  striving  to  live  up  to  its  opportunities  and  to  its  re- 
sponsibilities.    I  bespeak,  therefore,  that  aii>-  lingering  feelings  of 


RESPONSE    IN   ACCEPTING   TESTIMONIAL  11 

suspicion  or  of  unfriendliness  may  give  way  to  sentiments  of  amity 
and  of  cordial  cooperation. 

The  attitude  of  the  state  towards  medical  education  is  one  of  the 
most  important  factors  in  the  educational  problems  of  the  present 
day.  Until  recently  medical  schools  were  the  private  property  of 
those  who  conducted  them  and  were  regarded  by  the  public  and  by 
the  state  more  as  corporations  for  profit  than  as  integral  portions  of 
an  educational  system.  While  many  such  institutions  have  been 
founded  and  conducted  for  personal  gain  I  believe  that  those  that 
have  survived  the  vicissitudes  of  many  years  were  established  upon  a 
broad  humanitarian  basis.  I  especially  believe  that  the  school 
in  which  I  have  had  the  honor  of  holding  a  professorial  chair  for 
twenty-five  years  was  established  for  altruistic  purposes  and  not  for 
commercial  ones.  Ante-dated  by  Pennsylvania,  Harvard  and  Dart- 
mouth, and  chartered  in  the  same  year  as  Columbia,  the  medical 
school  of  the  University  of  Maryland  has  survived  the  shocks  of 
foreign  invasion  and  of  civil  strife  and,  though  poorly  equipped  in  a 
financial  sense,  it  has  ever  kept  up  fairly  well  in  the  march  of  prog- 
ress. The  time  has  now  arrived,  however,  when  the  state  must 
recognize  its  obligation  to  this  institution,  which  for  109  years  has 
to  a  large  extent  been  intrusted  with  the  duty  of  supplying  medical 
advisers  to  its  citizens.  I  am  happy  to  say  that  when  the  subject 
was  presented  to  the  last  Legislature,  in  an  absolutely  frank  and 
candid  manner,  the  necessities  of  the  school  were  recognized  and  the 
requisite  relief  was  granted.  I  am  profoundly  sensible  of  the  im- 
portance of  this  action,  as  it  is  a  concrete  evidence  of  the  recog- 
nition by  our  law  makers  of  the  fact  that  the  state  owes  an  obligation 
to  medical  education  as  much  as  to  other  branches  of  liberal  learning. 
It  gives  me  much  pleasure  to  express  our  great  obligation  to  the 
General  Assembly  for  rendering  this  absolutely  essential  aid,  and  to 
his  Excellency,  Governor  Harrington  for  signing  the  bill. 

I  ask  your  indulgence.  Gentlemen,  for  this  dull  and  prolix  talk. 
When  it  was  intimated  to  me,  recently,  that  some  of  my  former  pupils 
desired  to  pay  me  the  compliment  of  taking  some  notice  of  the  25th 
anniversary  of  my  election  as  a  member  of  the  faculty,  I  had  supposed 
that  it  would  have  taken  the  form  of  some  modest  token  of  respect, 
but  I  had  no  thought  that  I  should  be  the  recipient  of  any  such 
colossal  demonstration  as  this,  which  is  far  beyond  both  my  expecta- 
tion and  my  merit.  I  thank  you  individually  and  collectively  for 
this  great  honor  that  you  have  done  me.     I  know  something  of  the 


12  WILLIAM   S.    GARDNER 

immense  labor  that  Dr.  Stubbs  and  the  Committee  have  undergone 
in  order  to  make  this  occasion  such  a  great  success.  How  can  I 
adequately  thank  them?     I  am  unequal  to  the  task. 

In  the  first  class  that  graduated  after  I  became  a  professor  was  a 
modest  young  man  from  the  South.  He  is  now  the  Surgeon-General 
of  the  United  States  Public  Health  Service,  and  the  President-elect 
of  the  American  Medical  Association,  Dr.  Rupert  Blue — whose 
efficiency  in  eradicating  plague  in  San  Francisco,  and  elsewhere  in 
this  country,  has  made  his  name  known  and  honored  all  over  the 
world.  It  was  with  regret  that  we  have  just  learned  that  he  will  be 
unable  to  take  part  in  this  celebration.  I  extend  my  thanks  also  to 
the  Hon.  Albert  C.  Ritchie,  Attorney  General  of  Maryland,  and  to 
Dr.  Thomas  H.  Lewis,  President  of  Western  Maryland  College,  for 
their  illuminating  addresses;  and  I  respectfully  salute  Dr.  Thomas 
Fell,  Provost  of  the  University  of  Maryland  and  my  honored  col- 
leagues of  the  Board  of  Regents.  After  listening  to  the  much  too 
flattering  biographical  sketch  of  myself  by  my  genial  and  gifted  friend 
and  confrere,  Dr.  Ridgely  B.  Warfield,  I  find  myself  very  much  in 
the  plight  of  the  little  old  woman  who  fell  asleep  on  the  King's 
Highway,  and  whose  skirts  were  shorn  by  an  evil  disposed  person 
and  so  abbreviated  that  she  failed  to  recognize  herself,  and  with  her 
I  exclaim,  Lauk-a-mercy  on  me,  can  this  be  I! 

Friends,  former  pupils  and  colleagues,  again,  I  thank  you. 

INOPERABLE   CANCER   OF   THE   UTERUS—PERCY 
CAUTERY 

By  William  S.  Gardner,  M.D. 

The  urgent  necessity  for  having  some  method  of  treatment  of 
inoperable  carcinoma  of  the  uterus  is  apparent  to  everyone  who  has 
paid  any  attention  to  the  subject.  Nearly  70  per  cent  of  all  cancers 
of  the  uterus  that  are  admitted  to  the  hospitals  in  this  country  have 
advanced  so  far  that  it  is  impossible  to  completely  remove  them. 
These  patients  suffer  from  hemorrhage,  pain  and  the  results  of  in- 
toxication due  to  the  absorption  of  the  products  of  infection.  We 
have  up  to  very  recently  depended  upon  the  curette,  paquelin  cau- 
tery, opium  and  douches  to  render  these  patients  reasonably  com- 
fortable. Of  these  agents  the  most  efficient  is  the  cautery.  But  the 
paquelin  cautery  has  always  been  unsatisfactory  on  account  of  the 
high  temperature  at  which  it  is  used  is  very  likely  to  be  followed  by 


INOPERABLE  CANCER  OP  THE  UTERUS  13 

hemorrhage,  and  the  inefficiency  of  the  instrument  itself.  Dr.  Percy 
of  Galesburg,  111.,  has  introduced,  for  the  treatment  of  these  cases,  an 
electric  cautery,  the  temperature  of  which  can  be  regulated  to  any 
desired  degree,  which  is  reliable  and  retains  a  constant  temperature. 
Percy  states  that  the  value  of  his  method  of  using  the  cautery  de- 
pends upon  the  fact  that  cancer  cells  are  destroyed  when  their  tem- 
perature is  raised  to  113°F.  and  maintained  for  ten  minutes  and 
that  this  degree  of  heat  does  not  injure  the  normal  structures.  Percy 
is  very  careful  to  state  that  the  use  of  the  cautery  as  he  advocates  it 
is  only  a  palliative  remedy  but  that  the  use  of  the  heat  is  the  only 
method  by  which  a  gross  mass  of  cancer  can  be  safely  destroyed. 
The  immediate  result  is  a  marked  improvement  of  the  general 
physique.  He  is  also  convinced  that  the  activity  of  the  metastasis 
is  inhibited  because  the  destruction  of  the  gross  mass  permits  the 
natural  defensive  forces  of  the  body  to  become  more  active.  He  also 
beUeves  that  local  recurrences,  should  they  develop,  are  much  less 
active.  Pain  is  reheved,  the  hemorrhage  is  stopped  and  the  foul 
smeUing  discharge  ceases. 

He  states  of  the  utterly  inoperable  cases,  the  kind  with  the  100 
per  cent  mortality,  that  he  has  had  six  that  lived  beyond  the  three 
year  limit.  There  have  been  some  cases  of  secondary  hemorrhage 
but  Percy  states  that  since  tieing  both  internal  iliac  and  ovarian 
arteries  he  has  had  no  secondary  hemorrhage.  He  sums  up  his 
technic  as  follows : 

1.  Open  the  abdomen.  Only  by  doing  this  can  uterine  cancer  be 
safely  and  most  effectively  treated  by  the  apphcation  of  heat. 

2.  Use  a  low  degree  of  heat.  If  a  cauterizing  temperature  is  used 
in  the  heating  iron,  a  carbon  core  is  formed  in  the  cancer  mass. 
This  inhibits  the  dissemination  of  heat. 

3.  Pass  the  heating  head  through  the  uterocervical  junction  to  the 
fundus  of  the  uterus.  Keep  it  in  one  position  until  the  whole  mass 
contiguous  to  the  heating  iron  is  made  so  hot  that  it  cannot  be  held 
longer  in  the  surgeon's  hand  when  encased  in  a  medium-weight 
rubber  glove. 

4.  Apply  the  heat  until  all  of  the  structures  that  were  fixed  at  the 
beginning  of  the  application  are  freely  movable.  To  do  less  than  this 
must,  of  necessity,  defeat  the  object  of  the  treatment,  i.e.,  the  com- 
plete penetration  of  all  the  cancer  infected  area  possible.  Can 
this  be  done  in  every  case?  No.  Can  it  be  done  in  the  majority  of 
cases?     Yes. 


14  WILLIAM   S.    GARDNER 

Dr.  Balfour  of  the  Mayo  Clinic,  in  a  paper  on  the  relative  merits  of 
operation  for  cancer  of  the  uterus  states  that  experimentally,  it  has 
been  shown  that  cancer-cells  are  less  resistant  to  heat  than  normal 
cells  and  that  heat  prevents  successful  transplantation;  therefore  the 
tissues  to  as  great  a  distance  as  possible  from  the  local  lesion  should 
be  heated  to  a  point  which  will  prevent  the  progress  of  the  disease. 
The  heat  must  be  applied  slowly  for  at  least  one  hour.  He  became 
interested  in  Percy's  method  of  treatment  of  cancer  of  the  cervix 
about  two  years  ago  and  from  his  experience  in  more  than  one  hun- 
dred cases  is  convinced  of  its  great  value:  Its  essential  and  advan- 
tageous features  are:  (1)  the  slow  heating  process,  (2)  the  abdomen 
always  open,  (3)  the  gloved  hand  of  an  assistant  in  the  abdomen 
indicating  the  effectiveness  of  the  heating  process,  and  (4)  the 
water  cooled  speculum.  The  method  undoubtedly  offers  more  to  the 
patient  with  advanced  cancer  of  the  cervix  than  any  treatment  with 
which  they  are  familiar.  Its  value  is  so  definite  in  the  advanced 
stages  that  serious  consideration  must  be  given  its  possibilities  in  the 
earlier  stages  of  the  disease. 

Recently,  in  several  of  their  cases  of  advanced  cancer  of  the  cervix, 
the  Percy  treatment  has  been  accompanied  by  ligation  of  both 
internal  iliacs.  The  ultimate  benefits  of  this  procedure  cannot  yet 
be  foretold.  Attention  should  be  drawn  to  the  fact  that  in  stretching 
the  vaginal  tissues  in  order  to  use  large  specula,  secondary  carcino- 
matous nodules  may  develop  in  the  vagina  and  about  the  vulva. 
This  occurred  in  four  of  their  cases,  evidently  due  to  transplantation 
into  fissures  produced  by  the  stretching.  They  are  now  careful, 
after  any  operation  through  the  vagina,  to  thoroughly  remove  any 
particles  by  irrigation  and  then  swab  out  the  vagina  and  fissures 
with  Harrington's  solution  or  tincture  of  iodine  to  discourage  the 
occurrence  of  such  unnecessary  and  unfortunate  sequelae. 

For  the  moderately  advanced  cancer  of  cervix,  the  advantages  of  a 
two-stage  operation  have  graduallj''  become  apparent.  First,  treat- 
ment by  heat  (Percy  method)  as  in  the  inoperable  cases,  and  con- 
ducted as  though  no  further  operation  would  be  necessary;  second,  a 
total  abdominal  hysterectomy  some  weeks  later.  It  has  been  in- 
teresting to  note  that  of  sixteen  such  cases  operated  on  in  their 
clinic,  although  in  three  cancer-cells  were  still  present,  in  thirteen 
there  were  no  macfoscopic  or  microscopic  evidences  of  the  original 
disease.  Regardless  of  this  fact,  other  things  being  equal,  hebe- 
Heves  that  the  uterus  should  be  removed.     Although  the  results 


KIDNEY   INSUFFICIENCY   DURING    PREGNANCY  15 

following  the  clamp  and  cautery  operation  were  relatively  excellent, 
the  two  stage  operation  offers  distinct  advantages  and  they  are  em- 
ploying it  more  and  more  frequently. 

In  the  so-called  inoperable  cases,  heat  with  ligation  of  the  blood 
supply  limits  the  progress  of  the  disease,  stops  bleeding  and  discharge, 
improves  the  patient's  health  temporarily,  and  occasionally  converts 
what  is  apparently  quite  a  hopeless  inoperable  condition  into  an 
operable  condition. 

In  the  Boston  Medical  and  Surgical  Journal,  1915,  Cobb  reviews 
a  series  of  420  cases  of  cancer  of  the  uterus  treated  at  the 
Massachusetts  General  Hospital  from  1900  to  1914  inclusive.  Of 
these  36.1  per  cent  were  operable,  63  were  totally  inoperable  and  201 
only  paliative  operations  could  be  used. 

Cobb  states  that  the  advanced  cases  are  too  often  neglected  and 
beUeves  that  hgation  of  the  ovarian  and  internal  iUac  arteries  is  a 
valuable  means  of  stopping  pain  and  hemorrhage  in  these  advanced 
cases.  Previous  to  becoming  familiar  with  the  method  of  Percy  he 
had  been  ligating  the  internal  iliac  arteries  and  then  using  the 
curette  to  remove  diseased  tissue  and  charring  with  the  cherry-red 
cautery  iron.  Including  the  cases  done  by  the  Percy  method,  he 
has  ligated  the  internal  ihac  arteries  twenty-three  times  with  no 
immediate  mortality.  Cobb  believes  that  Percy's  method  is  the  one 
of  choice  in  borderline  and  advanced  cases  and  that  moderately  ad- 
vanced cases  which  in  the  past  have  been  operated  upon  radically, 
should  have  the  Percy  method  used  first  and  an  abdominal  hysterec- 
tomy done  later. 

Regarding  the  decision  as  to  which  cases  should  receive  radical 
operation,  the  author  states  that  while  such  cases  as  have  the  entire 
pelvis  filled  with  a  hard  mass  and  the  vagina  markedly  involved 
must  be  considered  inoperable,  there  are  numerous  cases  in  which  no 
bimanual  examination  with  or  without  anesthesia  can  positively 
determine  that  it  is  inoperable  because  fixation  of  the  uterus  and 
indurated  masses  in  the  pelvis  are  not  infrequently  due  to  inflamma- 
tory lesions.  In  such  cases  an  exploratory  laparotomy  is  necessary 
to  settle  the  question  of  radical  operation  and  since  the  Percy  treat- 
ment requires  opening  the  abdomen,  the  case  if  inoperable  is  ready 
for  his  treatment.  After  opening  the  abdomen,  the  peritoneum 
should  be  split  and  the  great  vessels  laid  bare.  If  large  nodes  are 
felt  in  the  sacral  chain  the  radical  operation  is  inadvisable. 

The  statement  of  Percy  that  the  heat  from  his  cautery  penetrates 


16  WILLIAM    S.    GARDNER 

deeply  into  the  tissues  destroying  the  cancer  cells  without  affecting 
the  normal  tissue  is  denied  by  Boldt.  The  latter  reports  the  autopsy 
findings  in  a  case  in  which  he  used  the  Percy  cautery  at  a  relatively 
low  temperature  for  two  and  a  half  hours.  The  patient  died  on  the 
eighth  day.  He  states  that  apparently  unaffected  cancer  nests 
were  within  1  mm.  of  the  necrotic  area  in  the  uterus  which  had  been 
produced  by  the  heat  and  that  3  mm.  from  where  all  the  tissues  were 
destroyed  by  the  cautery  that  the  cancer  cells  presented  no  mor- 
phological evidence  of  a  degenerative  change  and  that  many  of 
them,  especially  near  the  periphery  of  the  nest  were  in  the  process 
of  division.  In  other  words,  within  1  mm.  of  where  all  the  tissues 
were  destroyed  by  the  cautery  the  effect  on  the  cancer  cells  was  doubt- 
ful and  that  at  a  distance  of  3  mm.  there  was  no  effect  whatever. 
Until  he  noted  these  autopsy  findings  Boldt  believed  in  the  correct- 
ness of  the  statement  that  there  was  a  much  deeper  destruction  of 
the  cancer  cells  than  actually  occurs.  In  his  opinion  the  higher  de- 
grees of  heat  will  give  precisely  as  satisfactory  therapeutic  results 
despite  the  carbonization  as  the  lower  degrees.  In  fact,  one  may 
destroy  more  deeply  and  more  rapidly  with  the  high  degree  of  heat 
and  for  that  reason  it  is  superior  in  the  first  cauterization.  Boldt 
thinks  that  the  use  of  the  water-cooled  speculum,  the  opening  of  the 
abdomen  durmg  the  cauterization,  and  the  tying  off  of  the  uterine 
arteries  are  all  distinct  advances  to  be  credited  to  Percy. 

My  personal  experience  with  the  Percy  cautery  has  been  limited. 
During  the  past  two  years  I  have  used  it  in  a  number  of  moperable 
cases.  In  all  of  these  the  bleeding  and  discharge  were  controlled 
and  the  patient  was  made  at  least  temporarily  much  more  comfort- 
able. One  patient  on  which  the  cautery  was  used  January,  1915, 
was  entirely  without  symptoms  for  about  six  months.  She  had  been 
urged  to  report  frequently  for  examination  but  failed  to  do  so.  The 
result  of  a  second  cauterization  m  August,  1915,  there  was  a  slough- 
ing of  the  base  of  the  bladder  which  had  been  involved  by  the 
extension  of  the  carcinoma. 

One  of  the  fields  of  usefulness  of  the  Percy  cautery  is  the  conver- 
sion of  inoperable  carcinoma  of  the  cervix  into  an  operable  condition. 
The  most  favorable  cases  for  this  use  are  those  in  which  there  is  a 
large  cauliflower  growth  extending  from  the  cervix  out  into  the  va- 
gina. By  destroying  this  vaginal  growth  with  the  cautery  and 
waiting  until  there  is  a  partial  healing  it  is  possible  in  some  instances 
to  remove  the  uterus  and  wide  section  of  the  broad  ligaments. 


KIDNEY   INSUFFICIENCY   DURING    PREGNANCY  17 

My  use  of  the  cautery  has  convinced  me  that  it  is  a  valuable  in- 
strument. I  do  not  believe  that  it  will  accomplish  the  impossible, 
but  there  is  no  question  that  it  will  give  prolonged  relief  in  many 
desperate  cases.  Although  I  am  not  quite  ready  to  supplant  all 
operative  measures  for  the  removal  of  carcinoma  of  the  cervix  by 
the  use  of  the  cautery,  I  believe  that  as  many  if  not  more  relatively 
early  epitheliomata  of  the  cervix  can  be  cured  by  the  cautery  than 
by  any  cutting  operation. 

KIDNEY  INSUFFICIENCY  DURING  PREGNANCY 
By  J.  M.  H.  Rowland,  M.D.,  F.A.C.S. 

"Pregnancy  is  the  supreme  test  of  kidney  efficiency."^  Cer- 
tainly few  conditions  of  life  make  such  demand  upon  this  organ; 
and  it  frequently  fails  to  meet  the  test.  So  much  is  this  true,  that 
kidney  function  becomes  the  point  about  which  our  interest  centers 
during  pregnancy,  more  than  any  other  related  condition. 

It  was  my  intention  when  I  promised  to  read  this  paper,  to  try  to 
simplify,  or  rather  to  clarify,  the  various  prevalent  impressions 
concerning  the  kidney  complications  of  pregnancy. 

In  reading  the  various  text-books  of  medicine,  surgery  and  ob- 
stetrics, one  would  gain  the  impression  that  nephritis  during  preg- 
nancy, exclusive  of  the  acute  changes  incident  to  eclamptic  toxaemia, 
due  to  pregnancy  is  rather  common;  and  one  might  think,  reading 
from  the  same  sources,  that  convulsions  occurring  in  the  course  of 
nephritis  in  pregnancy,  excluding  eclampsia,  is  also  not  uncommon. 

It  is  my  own  impression  that  nephritis  due  to  the  pregnant  con- 
dition, not  present  before  pregnancy  and  not  due  to  preeclamptic  or 
eclamptic  toxaemia,  is  rather  rare. 

We  are  all  acquainted  with  the  acute  degenerative  changes  taking 
place  in  the  kidneys  accompanying  eclampsia,  and  when  autopsies  are 
secured,  always  shown  to  be  accompanied  by  and  probably  preceded 
by  the  characteristic  changes  in  the  liver.  Practically  the  same  kid- 
ney changes  are  produced  by  many  other  toxic  substances  (scarlet 
fever,  diphtheria,  drugs),  but  the  cause  here  is  not  pregnancy  but  the 
toxic  agent  or  irritant,  and  while  the  toxic  agent  in  eclampsia  is  due 
to  pregnancy,  it  is  effective  so  far  as  the  kidney  is  concerned  only 

1  Barnes. 


18  J.    M,    H.    ROWLAND 

subsequent  to  other  and  more  important  changes  and  the  kidney 
change  is  only  one  of  the  results  of  a  very  serious  toxaemia. 

We  know  that  many  cases  of  pregnancy  are  complicated  by  a 
nephritis  or  what  might  more  truly  be  said,  many  cases  of  nephritis 
are  complicated  by  pregnancy;  for  it  is  my  sincere  conviction  that 
nephritis  unrelated  to  some  definite,  generally  easily  discoverable 
cause,  such  as  acute  infectious  diseases  or  eclampsia  or  other  toxic 
agents,  does  not  occur  in  pregnancy  as  a  result  of  the  pregnancy 
alone. 

The  so-called  kidney  of  pregnancy  is  of  such  frequent  occurrence 
that  we  must  admit  that  pregnancy  does  make  severe  demands  on 
the  kidney  and  that  during  pregnancy  the  kidney  is  in  a  very  sus- 
ceptible state  to  say  the  least,  and  following  out  the  theory  that 
even  slightly  abnormal  conditions  of  the  body  or  of  any  organ  or 
tissue  make  for  lessened  resistance,  it  might  easily  be  the  case  that  the 
slight  degeneration  due  to  pregnancy  might  be  a  factor  in  bringing 
about  a  nephritis  durmg  toxaemic  irritation.  This  cannot  be  denied; 
but  further  than  this  I  am  doubtful  of  its  contribution  to  the  etiology 
of  nephritis. 

It  seems  to  me  that  clinically,  as  the  general  practitioner  or  ob- 
stetrician sees  them,  the  nephritic  complications  of  pregnancy  divide 
themselves  into  four  very  distinct  groups. 

(1)  Mild  manifestations  late  in  pregnancy. 

(2)  Changes  accompanying  preeclamptic  toxaemia  and  eclampsia. 

(3)  Nephritis. 

(4)  Pyogenic  conditions  of  the  kidney. 

CLINICAL    GROUP  NUMBER  1 

(1)  Mild  manifestations  late  in  pregnancy.  Most  frequent — 
slight  evidence  of  defective  kidney  action  or  bodily  metabolism 
showing  albumen,  generally  in  small  amounts,  slight  oedema,  few 
hyaline  casts,  sometimes  granular  casts,  diminished  quantity  of 
urine,  slight  increase  of  blood  pressure,  headache,  occurs  late  in 
pregnancy,  usually  yields  to  purgatives,  meat  free  diet  or  milk  diet 
and  rest  in  bed. 

The  prognosis  for  both  nother  and  child  is  quite  good  in  multi- 
parous  women  and  quite  good  for  mother  and  fairly  good  for  child 
in  primiparous  women;  the  diagnosis  being  a  little  worse  for  the 
child  because  of  prematurity  and  occasional  operative  delivery. 


KIDNEY   INSUFFICIENCY   DURING    PREGNANCY  19 

Diagnosis,  whether  of  toxaemia  or  nephritis  is  somewhat  difficult. 
My  inchnation  is  to  believe  that  the  great  majority  are  toxic. 
Treatment  is  however  the  same. 

These  cases  are  apt  to  be  delivered  a  little  earlier  than  expected, 
i.e.,  a  week  or  ten  days  before  full  term. 

No  permanent  damage  occurs  to  the  kidneys,  the  examination  of 
urine,  blood  pressure,  etc.  at  the  end  of  puerperium  showing  complete 
recovery. 

CLINICAL    GROUP   NUMBER   2 

Preeclamptic  toxaemia  and  eclampsia.  The  second  most  frequent 
clinical  type  is  the  condition  known  as  preeclamptic  toxaemia  and 
eclampsia,  which  usually  comes  on  later  than  the  fifth  month  (sixth 
to  tenth)  with  a  fairly  rapid  development. 

The  symptoms  are  oedema,  coming  on  rather  rapidly,  showing 
first  in  the  extremities,  appearing  last  in  the  face  and  when  ap- 
pearing there,  showing  a  diffuse  puffiness  which  broadens  or  fat- 
tens the  face  rather  than  as  a  dropsical  condition  of  eyelids  as  we 
have  in  other  conditions.  This  oedema  may  be  pronounced  but 
does  not  usually  reach  any  extreme  degree,  and  disappears  rapidly 
during  the  puerperium. 

Diminished  amount  of  urine.  This  condition  may  vary  from  a 
slight  diminution  to  complete  anuria.  If  convulsions  ensue  the 
quantity  of  urine  is  usually  quite  small.  Albumin  is  present  in 
practically  all  cases,  though  I  have  seen  two  cases  in  which  albumin 
did  not  occur  until  after  convulsions  had  supervened  (in  one  case 
twenty-four  hours  after  convulsions  had  ceased).  The  albumin  in 
cases  of  marked  toxaemia  is  usually  in  large  quantities,  the  urine 
frequently  almost  entirely  solidifying  on  heating. 

The  albumin  usually  disappears  rapidly  if  patient  recovers,  fre- 
quently disappearing  in  two  or  three  days  in  mild  cases  and  in  two  or 
three  weeks  in  severest  cases.  Casts  are  present,  usually  hyaline  and 
granular,  sometimes  epithelial.  Blood  pressure  is  usually  increased 
quite  materially — systolic  increasing  from  140  to  190  mm.  Hg. 
Headache  is  frequently  present,  is  more  or  less  intractable  in  severe 
toxaemia  and  is  often  accompanied  by  slight  disturbance  of  vision, 
which  just  before  convulsions  ocaur,  frequently  becomes  complete 
blindness.  There  is  however  no  retinal  change  except  a  slight 
oedema  or  small  punctate  hemorrhages  which  disappear  rapidly  after 
delivery. 


20  J.    M.    H.    ROWLAND 

Jaundice  may  be  present  and  is  always  of  grave  prognostic  signifi- 
cance. 

If  the  case  comes  to  autopsy,  in  addition  to  the  kidney  changes 
there  are  present  the  characteristic  changes  in  the  liver  which  mark 
the  case  as  one  definitely  eclamptic. 

CLINICAL   GROUP   NUMBER   3 

Nephritic  toxaemia.  In  contrast  to  the  eclamptic  variety,  we  pre- 
sent the  picture  of  the  type  which  is  definitely  nephritic.  Here  we 
have  usually  a  patient  who  has  possibly  given  us  some  anxiety  on 
account  of  her  kidneys  before  pregnancy,  sometimes  as  a  result  of 
scarlet  fever,  or  typhoid,  or  for  other  reasons.  Her  condition  may 
have  improved  under  treatment,  she  may  seem  to  have  entirely  re- 
covered. In  such  a  case,  if  pregnancy  supervenes,  the  kidney  again 
shows  insufficiency  and  it  shows  it  quite  early,  frequently  as  early  as 
the  second  or  third  month  and  oedema,  albumin,  casts  appear. 
Blood  pressure  is  increased  considerably  from  the  start  and  soon 
reaches  a  fairly  high  mark,  the  majority  of  these  cases  reaching  sys- 
tolic pressure  of  200  mm.  early  in  pregnancy  and  frequently  going 
much  higher  than  this.  It  is  in  these  cases  that  the  definite  changes 
in  the  retina  known  as  albuminuric  retinitis  appear,  which  condition 
does  not  disappear  after  delivery,  but  remains  as  a  more  or  less  per- 
manent anatomical  change,  with  however  usually  some  improvement 
in  vision.  These  conditions  come  on  slowly  but  they  are  persistent 
and  grow  consistently  in  gravity.  If  the  preexisting  kidney  lesion 
has  been  very  slight,  the  symptoms  may  be  late  in  appearing,  but 
with  the  exception  of  retinitis  they  inevitably  appear  and  the  time 
of  their  appearance  is  early  or  late  in  direct  proportion  to  the  amount 
of  preexisting  kidney  disability. 

The  most  remarkable  contrast  in  the  two  conditions  is  in  the  uri- 
nary changes.  The  evidences  of  kindey  insufficiency  attending 
eclamptic  conditions  are  acute,  definite  and  frequently  alarming  and 
serious,  indeed  the  condition,  if  not  relieved,  progresses  rapidly 
through  its  various  stages  until  complete  anuria  is  reached.  The 
remarkable  thing  about  nephritis  due  to  or  accompanying  eclampsia 
is  however,  that  if  the  patient  recovers,  the  kidney  condition,  no 
matter  how  severe  during  the  eclamptic  attack  usually  eventually 
clears  up  and  frequently  clears  up  very  quickly.  Indeed  only  a  few 
days  sometimes  intervene  between  the  most  pronounced   kidney 


KIDNEY   INSUFFICIENCY   DURING   PREGNANCY  21 

change,  as  evidenced  by  the  condition  of  the  urine  or  complete 
anuria  and  what  seems  to  be  entire  functional  health  of  the  same 
kidneys. 

This  is  not  true  where  the  condition  is  one  definitely  nephritic 
rather  than  eclamptic.  Here  the  kidney  insufficiency  remains,  and 
perhaps  months  after  delivery,  the  urine  still  shows  albumen  and 
casts,  etc.  but  almost  always  in  greatly  diminished  quantity.  If  the 
kidney  change  is  not  great,  the  urine  will  entirely  clear  up,  but  if  the 
changes  have  been  decided,  convalescence  is  slow  and  the  in- 
sufficiency is  more  or  less  permanent. 

Eclampsia  Nephritis 

Oedema  late,  comes  on  rapidly.  Oedema  early,  increases  slowly. 

Albumin  late.  Albumin  early. 

Headache  late.  Headache  early. 

Increased  blood  pressure  140  to  190.  Increased  blood  pressure  frequently 

No  previous  history  of  nephritis.  as  high  as  230  to  240. 

No  recent  history  of  scarlet  fever,  Previous  history  nephritis. 

typhoid,  etc.  Recent  history  of  scarlet  fever,   ty- 

Disturbance  of  vision  comes  on  rap-  phoid,  tonsilitis,  etc. 

idly  and  appears  late.  Disturbance  of  vision  comes  on  early 

Retina  shows   either   no   change   or  and  slowly  increases  consistently. 

only     slight      odema,     or     slight  Retina  may  show  definite  changes  of 

hemorrhage.  albuminuric  retinitis. 

Convulsions  frequently  occur.  Convulsions  seldom  occur. 

After  delivery.  Rapid  recovery  from  After  delivery.  Slow  and  only  par- 
kidney  insufficiency  and  disturb-  tial  recovery  from  kidney  insuffi- 
ance  of  vision.  Retinal  changes  ciency.  Retinal  changes  remain 
entirely  disappear.  with  little  improvement. 

The  nephritic  case  always  tends  to  terminate  prematurely,  few 
cases  going  to  full  term  even  if  allowed  to  take  their  course,  without 
interference.  Spontaneous  delivery  from  five  to  eight  months  of  a 
dead  child  or  a  puny  child  which  dies  a  few  hours  or  days  after 
delivery  is  the  rule,  and  in  any  event  the  delivery  of  a  child  which 
survives  is  the  great  exception.  One  very  unfortunate  happening  may 
occur,  fatal  to  all  children  and  to  about  50  per  cent  of  mothers,  the 
premature  separation  of  a  normally  implanted  placenta.  I  have 
seen  this  accident  five  times  in  nephritic  cases,  all  the  children  being 
born  dead,  all  the  mothers  surviving. 

The  eclamptic  case  also  tends  to  terminate  early  but  not  so  early 
as  the  nephritic  and  is  much  more  likely  to  go  to  full  term.  Once 
convulsions  ensue,  uterine  contractions  usually  start  up  and  a  pa- 


22  J.    M.    H.    ROWLAND 

tient  may  be  delivered  without  the  attendant's  knowledge.  I  have 
known  this  to  occur  twice.  The  child  of  the  eclamptic  is  much 
more  worth  saving,  being  much  more  likely  to  grow  than  the  child 
of  the  nephritic  case. 

CLINICAL   GROUP   NUMBER  4 

Pyogenic  conditions 

The  clinical  course  of  pregnancy  in  these  conditions,  depends  en- 
tirely upon  whether  the  suppurative  condition  is  present  in  the 
kidney  before  pregnancy  supervenes,  or  whether  the  suppurative  con- 
dition appears  during  pregnancy  as  the  result  of  an  infection  and 
blocking  of  the  ureter. 

In  the  first  class  pregnancy  almost  immediately  aggravates  the 
existing  insufficiency  and  as  early  as  the  second  or  third  month, 
symptoms  grave  enough  to  demand  interference  are  frequently  pres- 
ent, and  while  it  is  true  of  these  as  of  all  cases  of  kidney  insufficiency 
during  pregnancy  that  the  symptoms  are  in  direct  proportion  to  the 
amount  of  damaged  kidney  tissue,  it  is  seldom  true  that  with  a 
preexisting  suppurative  condition  of  the  kidney  pregnancy  will  pro- 
ceed to  a  fortunate  and  successful  termination. 

Pyelo-nephrosis  coming  on  during  pregnancy  and  which  appears 
about  or  after  the  fifth  month,  which  is  frequently  due  to  pressure 
of  the  pregnant  uterus  on  the  ureter  plus  an  infection,  and  which 
is  not  an  uncommon  complication  of  pregnancy,  will  usually  recover 
if  treated  by  rest,  large  quantities  of  water,  urotropin,  etc.  If  the 
condition  does  not  yield  to  treatment,  it  will  be  necessary  to  empty 
the  uterus  which  usually  relieves  the  condition.  If  the  condition 
is  not  relieved,  death  from  general  sepsis  may  ensue. 

In  these  as  in  all  conditions  in  which  kidney  insufficiency  is  pres- 
ent, the  obstetrician  must  stand  ready  to  terminate  pregnancy  in  the 
interest  of  the  mother  whenever  the  symptoms  demand  it. 

ADVICE  AS  TO  FUTURE  PREGNANCIES 

In  the  first  group,  subsequent  pregnancy  should  not  be  discour- 
aged but  any  pregnancy  following  any  sort  of  kidnej'"  insufficiency 
should  be  watched  with  extreme  care. 

This  applies  also  to  the  second  group — the  preeclamptic  toxaemia 
eclampsia. 


UNUSUAL    CASES    OP   DISEASE    OF   NASAL   SINUSES  23 

In  the  third  group,  the  nephritic  cases,  it  is  my  opinion  that  fu- 
ture pregnancies  should  be  discouraged,  as  the  probability  of  a  suc- 
cessful termination  of  the  pregnancy  without  too  serious  damage  to 
the  mother  is  very  remote. 

Of  the  fourth  group,  those  women  with  chronic  supparative  con- 
ditions of  the  kidney  should  not  become  pregnant,  as  it  is  extremely 
unlikely  that  any  of  these  will  go  to  full  term. 

A  REPORT  OF  SOME  UNUSUAL  CASES  OF  DISEASE  OF 
THE  NASAL  ACCESSORY  SINUSES^-^ 

[Abstract] 

By  John  R.  Winslow,  M.D. 

Baltimore,  Md. 

This  paper  presents  the  histories  of  four  cases,  whose  title  is  an 
adequate  indication  of  their  nature: 

Case  1.  A  case  of  congenital  membranous  obstruction  of  the 
choana,  complicated  by  unilateral  endo-nasal  atresia,  and  double 
suppurative  spheno-ethmoiditis.     Operation.     Practical  cure. 

Case  2.  A  case  of  melancholic  dementia  due  to  chronic  spheno- 
ethmoiditis.     Cured  by  operation. 

Not  only  the  mental,  but  the  general  physical  condition  of  this 
patient  was  rejuvenated  by  operation. 

Case  3.  A  case  of  suppurative  spheno-ethmoiditis  simulating 
ozena,  and  causing  mental  confusion,  impaired  memory,  intense 
headache  and  blurred  vision.     Cured  by  operation. 

In  addition  to  anatomic  abnormalities  and  operative  difficulties, 
this  case  presents  an  interesting  question  as  to  the  nature  of  certain 
convulsiform  seizures  preceding  and  following  the  several  operations 
— particularly  their  relation  to  a  possible  latent  epileptic  tendency. 

Case  4-  A  case  of  fracture  of  the  skull,  involving  the  left  frontal 
sinus,  roof  of  orbit  and  nasal  wall,  producing  a  self-performed  Kil- 
lian  operation.  Exposure  of  the  brain.  Subsequent  infection  and 
empyema  of  the  frontal  sinus,  draining  through  the  nose.  Opera- 
tion.    Cure? 

Whether  of  traumatic  or  other  origin,  this  result  can  be  regarded 
in  no  other  light  than  as  an  almost  miraculous  one. 

^Presented  to  the  American  Laryngological  Association  at  Niagara  Falls, 
Canada,  June,  1915. 

^Reprint  from  Annals  OtoL,  Laryngol.  and  Rhinol.,  September,  1915. 


BULLETIN 

OF    THE 

University  of  Maryland  School  of  Medicine 

AND 

College  of  Physicians  and  Surgeons 


Publication  Committee 

Randolph  Winslow,  A.M.,  M.D.,  LL.D.  \Vm.  S.  Gardner,  M.D. 

J.  M.  H.  Rowland,  M.D. 

Nathan  Winslow,  A.M.,  M.D.,  Editor 

Associate  Editors 

Albert  H.  Carroll,  M.D.  Andrew  C.  Gillis,  A.M.,  M.D. 

John  Evans,  M.D. 


To  Our  Joint  Alumni  and  Our  Friends  Everywhere  :  Greeting 
Owing  to  the  several  mergers  that  have  taken  place  between  the 
University  of  Maryland,  the  Baltimore  Medical  College  and  The 
College  of  Physicians  and  Surgeons,  it  has  seemed  best  to  change 
the  name  of  the  publication  of  the  medical  school  from  The  Hospital 
Bulletin  of  the  University  of  Maryland  to  The  Bulletin  of  the 
University  of  Maryland,  School  of  Medicine  and  College 
of  Physicians  and  Surgeons.  The  new  Bulletin,  of  which  this 
issue  is  Volume  I,  No.  1,  will  appear  ten  times  a  year  but  the  July 
number  will  be  the  annual  announcement  and  catalogue.  There 
will  be  no  issues  in  August  and  September.  In  appearance  the  new 
Bulletin  will  also  differ  materially  from  the  old  one.  The  Hospital 
Bulletin  Company  was  a  private  corporation,  though  devoted 
exclusively  to  the  interests  of  the  Medical  School  and  was  purely 
philanthropic  in  character.  The  present  Bulletin  is  issued  by  the 
institution  itself,  under  the  supervision  of  a  committee  of  the  faculty. 
There  is  no  stock  and  there  will  be  no  profits  to  be  divided  between 
anybodj^  As  the  scope  of  the  journal  will  be  widely  extended  it 
is  hoped  that  a  greatly  increased  number  of  readers  will  welcome 
its  arrival;  and  that  a  large  increase  in  the  contributions  of  papers 
will  be  secured. 

We  extend,  therefore,  our  warm  greetings  to  our  friends  and  alumni 
and  bespeak  their  kind  interest  in  our  new  enterprise. 

The   Endowment    Fund    for    the    Pathological    Department 

For  the  benefit  of  our  new  readers  we  desire  to  announce  that  we 

had  been  in  the  habit  of  pul:)lishing  from  time  to  time  in  The  Hospital 

24 


EDITORIALS  25 

Bulletin  contributions  to  an  endowment  fund  for  the  pathological 
department.  It  is  still  necessary  to  raise  $80,000  to  complete  this 
fund,  more  than  $20,000  being  in  hand.  Any  contribution  you  may 
see  fit  to  make  will  be  very  acceptable,  acknowledgment  of  which 
will  be  made  in  these  columns. 

We  take  pleasure  in  acknowledging  the  receipt  in  May  of  a  con- 
tribution from  Dr.  C.  B.  Williams,  of  Philippi,  W.  Va.,  of  $25. 

THE  ANNUAL  COMMENCEMENT 

The  one  hundred  and  ninth  annual  commencement  of  the  Univer- 
sity of  Maryland  was  held  at  the  Lyric  Theater,  Thursday  afternoon, 
June  1,  1916,  at  4  o'clock,  before  an  appreciative  audience,  which 
packed  the  theater. 

Governor  Emerson  C.  Harrington,  St.  John's  College,  class  of 
1884,  wearing  the  robes  of  a  doctor  of  laws,  delivered  the  annual 
oration  to  the  graduates  and  presented  them  with  their  diplomas. 

The  order  of  exercises  was  as  follows : 

Overture — "Ruy  Bias" Mendelssohn 

Selection — "Lohengrin" Wagner 

Gems  from  "All  Over  Town" Hein 

Fantasia — "America" Tobani 

1.  Music — March,  "Coronation" Kretschmer 

2.  Prayer  by  Rev.  Phillip  Cook. 

3.  Music— "Cavatina" Roff 

4.  Address  to  the  Graduates — -His  Excellency,   Hon.   Emerson  C. 

Harrington,  LL.D.,  Governor  of  Maryland. 

5.  Solo Selected 

6.  Conferring  of  Degrees  by  the  Provost  of  the  University. 
Candidates  for  the  Degrees  "Bachelor  of  Arts"  and  "Bachelor  of 

Sciences"  presented  by  the  Dean  of  the  Faculty  of  Arts  and 

Sciences. 
Candidates  for  the  Degree  "Doctor  of  Medicine"  presented  by  the 

Dean  of  the  Faculty  of  Physic. 
Candidates  for  the  Degree  "Bachelor  of  Laws"  presented  by  the 

Dean  of  the  Faculty  of  Law. 
Candidates  for  the  Degree  "Doctor  of  Dental  Surgery"  presented 

by  the  Dean  of  the  Faculty  of  Dentistry. 
Candidates  for  the  Degree  "Doctor  of  Pharmacy"  presented  by 

the  Dean  of  the  Faculty  of  Pharmacy. 

7.  Conferring  of  Honorary  Degrees. 

8.  Music — "Japanese  Patrol" VerrS 

9.  Award  of  Prizes. 

10.  Music — March,  "Orange  Blossom  Time" Branen 

Prof.  Fritz  Gaul,  Director  of  Music 


26 


EDITORIALS 


There  were  260  graduates.     They  were  presented  by  the  deans  of 
their  respective  departments,  and  were  classified  as  follows : 


Bachelor  of  Arts 6 

Bachelor  of  Science 10 

Doctor  of  Medicine 123 


Bachelor  of  Laws 53 

Doctor  of  Dental  Surgery 47 

Doctor  of  Pharmacy 21 


Students  who  received  decrees  were : 


Bachelor  of  Arts 


George  Ewell  Dryden 
Arthur  Brenner  Jacques 
Robert  Otis  Jones 


Thomas  Watkins  Ligon 
Harry  Joseph  Selby 
Joseph  Dent  Hungerford 


Bachelor  of  Science 


Fred  Bielaski 
Thomas  Eugene  Bourke 
James  Thomas  Duke 
Charles  Lester  Hartsock 
Gabriel  Thornton  Mackenzie 


Chauncey  St.  Claire  McNeill 
Jacob  Myers  Pearce,  Jr. 
Frederick  Weston  Hyde 
William  Francis  Stromeyer 
Abram  Wright  Williams 


Doctor  op  Medicine 


David    McAllister    Aikman,     Penn- 
sylvania 
Franklin  B.  Anderson,  Maryland 
Richard  Turberville  Arnest,  Virginia 
Bartus  Trew  Baggott,  Maryland 
George  Abner  Bawden,  Maryland 
Foster  A.  Beck,  Pennsylvania 
Percival     Robert     Bennett,     North 

Carolina 
Edward  H.  Benson,  Maryland 
William  Ernest  Bickley,  South  Caro- 
lina 
Benjamin  Harrison  Biddle,  Ohio 
Everett  Lassiter  Bishop,  Georgia 
Thomas  Latham  Bray,  North  Caro- 
lina 
Charles  R.  Brooke,  Maryland 
Thomas  E.  Brown,  Jr.,  Pennsylvania 
Benjamin   Bruce  Brumbaugh,  Mary- 
land 
Henry  Fred  John  Buettner,  Maryland 
Charles  Hammon  Burton,  Maryland 
Ignatius  P.  A.  Bj^rne,  New  York 
Paul  Conway  Carter,  North  Carolina 
Honorie  F.  Carrasquillo,  Porto  Rico 


Michael  Edward  Cavello,  New  York 
James  J.  Chandler,  South  Carolina 
Lucien  R.  Chaput,  Massachusetts 
C.  Chapin  Childs,  New  York 
Lewis  Furbeck  Cole,  New  York 
John  William  Coltrain,  North  Caro- 
lina 
A.  Fillmore  Compton,  West  Virginia 
James  Erric  Cudd,  South  Carolina 
William    Joseph    Dillon,    Massachu- 
setts 
Torrias  Dominguez,  Porto  Rico 
Edward  P.  Dunne,  Connecticut 
John  E.  Evans,  South  Carolina 
Fred  L.  EyeStone,  Ohio 
Israel  J.  Feinglos,  Maryland 
Maurice  Feldman,  Maryland 
Willie  Todd  Ferneyhough,  Virginia 
Bernard  Joseph  Ferry,  Pennsylvania 
Max  Finkelstein,  New  York 
William  H.  Flynn,  Connecticut 
Fred  F.  Foard,  Jr.,  North  Carolina 
Joseph  D.  Foley,  Connecticut 
Robert  Hamilton  Folk,  South  Caro- 
lina 


EDITORIALS 


27 


Raymond  K.  Foxwell,  Maryland 

Clarence  Lee  Gannon,  New  York 

Peter  W.  Gatsopoulos,  Massachusetts 

Harold  E.  Gillett,  New  York 

Lewis  W.  Glatzau,  Florida 

Harry  Goldman,  Marjdand 

Jose    Felipe    Gonzales    y    Gonzales, 

Porto  E-ico 
Bowers  H.  Growt,  Maryland 
Edward  T.  Gruetzner,  Pennsylvania 
George      Humphrey      Gwynn,      Jr., 

Florida 
Humphrey  Wilson  Gwynn,  Florida 
Howell  Inskip  Hammer,  Maryland 
S.  Roscoe  Hanigan,  Pennsylvania 
Albert  Gaither  Hawn,  North  Carolina 
J.  Roy  Hege,  North  Carolina 
Jay  Tyrrell  Hennessy,  New  York 
Lewis  H.  Howard,  Maryland 
Frank  S.  Hundley,  Maryland 
Daniel  Cogdell  Hutton,  North  Caro- 
lina 
Bernard  S.  Jacobson,  Maryland 
Lee  Henry  Knapp,  New  Hampshire 
Paul  Maxwell  Kyle,  West  Virginia 
Allen  D.  Lazenby,  Maryland 
Ellsworth  Emmett  Light,  Massachu- 
setts 
Clark  Samuel  Long,  Pennsylvania 
Eufemio  N.  Becauegra  Lopez,   Porto 

Rico 
Bernard  Henry  Lovely,  New  Hamp- 
shire 
Charles  H.  Lupton,  North  Carolina 
William  L.  Madden,  New  Jersey 
Frank  C.  Marino,  Maryland 
Jacob  Henry  Matthai,  Illinois 
Kenneth  E.  McCamey,  Pennsylvania 
George  McLean,  Maryland 
Francisco  J.  Mejias,  Porto  Rico 
Henry  Anton  Merkel,  Maryland 
Lawrence  G.  Miller,  Maryland 
John  E.  Miller,  Vermont 
Ricardo  Ramirez  y  Morales,   Porto 

Rico 
A.  Boynton  Nevling,  Pennsylvania 
Frank  P.  Nicholson,  New  York 


Robert  Holman  Noell,  North  Caro- 
lina 
Joseph  Gerald  O'Brien,  Maryland 
Thomas  Francis  O'Brien,  Connecticut 
Vincent  Oddo,  New  York 
Jacob  Oduber,  Dutch  West  Indies 
William  F.  O'Malley,  New  York 
Gonazlo  O'Neill,  Jr.,  New  York 
Bartholomew  Charles  Pasuth,   Con- 
necticut 
George  R.  Patrick,  North  Carolina 
Arthur  F.  Peterson,  Massachusetts 
Fernando  Penabaz,  Cuba 
Guy  Reyman  Post,  West  Virginia 
Carl  M.  Van  Poole,  North  Carolina 
Samuel  O.  Pruitt,  South  Carolina 
M.  G.  de  Quevedo,  Porto  Rico 
Adam  William  Reier,  Maryland 
Charles  Adam  Reifschneider,  Mary- 
land 
George  William  Rice,  Maryland 
Cecil  Rigby,  South  Carolina 
Joseph  John  Roberts,  Connecticut 
Herbert  W.  Rogers,  Virginia 
Julio  R.  Rolenson,  Porto  Rico 
F.  Frederick  Ruzicka,  Maryland 
Angel  M.  Santos-Buch,  Cuba 
Wilbur    Fiske    Shirkey,     Jr  ,     West 

Virginia 
Noah  Hageman  Short,  West  Virginia 
William  Henry  Sloan,  North  Carolina 
Samuel  Snyder,  Maryland 
Harold  Milton  Stein,  New  Jersey 
Abraham  Tobias  Sternberg,  Palestine 
Herbert  Lawrence  Strandberg,  New 

Jersey 
Edward  Franklin  Syrop,  New  York 
Edward  P.  Thomas,  Maryland 
Thomas  Gooch  Tickle,  West  Virginia 
Norwood  W.  Voss,  Maryland 
Harrison  M.  Wellman,  Pennsylvania 
Maurice  Cornelius  Wentz,  Maryland 
William  Oscar  Whittle,  Virginia 
W.  F.  Williams,  Maryland 
Humphrey  D.  Wolfe,  Maryland 
Benjamin  Meyer  Yaffe,  Maryland 


28 


EDITORIALS 


Prizemen 

University   Group 

University  Prize,  Gold  Medal — Frank  C.  Marino 

Certificalea  of  Honor 
Bernard  S.  Jacobson  Honorio  F.  Carrasquillo 


Harrison  M.  Wellman 


Cecil  Rigby 


Robert  H.  Folk 


College  of  Physicians  and  Surgeons  Group 

Medal  Men 
Kenneth  E.  McCamey  Lewis  H.  Howard 

Humphrey  D.  Wolfe  Guy  R.  Post 

Entitled  to  Honorable  Mention 


D.  M.  Aikman 

E.  P.  Dunne 


Wendell  DeWitt  Allen 
Prospero  Amato 
John  Denny  Armstrong 
William  Lester  Baldwin 
J.  Kemp  Bartlett,  Jr. 
Robert  Wesley  Barry 
Guy  Bertrand  Brown 
Arthur  Webster  Bryan 
Morton  Yates  Bullock 
James  Charles  Byrne 
Robert  Joseph  Caplan 
Paul  Owens  Carter 
Edward  Joseph  Coolahan 
Dudley  George  Cooper 
William  Hoskins  Cooper 
Roger  Bernard  Copinger 
Charles  Maier  Cover 
James  Burgess  Diggs 
Lloyd  Dorsey,  Jr., 
Sigmund  Eisenberg 
John  Aloysius  Farley 
William  L.  Galvin 
Robert  Gordon  Gambrill 
George  Lewis  Goff 
Howell  Corbin  Gwaltney 
William  Scott  Gwynn 
Walter  Van  A.  Harrison 


George  McLean 
A.  F.  Peterson. 


Bachelor  of  Laws 


Henry  William  Hess 
John  McNeil  Holmes 
Robert  Kanter 
Jacob  Kartman 
Edwin  Brown  Kelly 
George  Edgar  Kieffner 
Harry  A.  Kohlerman 
Gerald  Fry  Kopp 
Lucius  Q.  C.  Lamar 
Harry  Vernon  Leitch 
David  Carter  Levinson 
Herbert  Levy 
Hugh  A.  McMullen,  Jr., 
Norman  Travers  Nelson 
James  Leo  O'Connor 
Andrew  Wendell  Pardew 
Edward  Henry  Plumer 
John  G.  Ray 
Frederick  H.  Riehl 
Ellis  Rosenberg 
Francis  Joseph  Sayler 
Isidor  William  Schimmel 
Otto  Carl  Schmied 
Irvin  Jerome  Sullivan 
Daniel  Ferdinand  Turpin 
Hilbert  Amil  Waldkoenig 


EDITORIALS 


29 


Doctor  of  Dental  Surgery 


James  Malcolm  Adair,  Virginia 
Arthur  Clinton  Albert,  West  Virginia 
Albert  Zimmerman  Aldridge,  Mary- 
land 
Max  Kentz  Baklor,  Maryland 
Walter  Edward  Bean,  New  York 
John  Patrich  Bell,  Maryland 
Danzell  Cicero  Blevins,  North  Caro- 
lina 
Gerald  Ivanhoe  Brandon,  Jamaica 
Thomas  Olin  Broadwater,  Maryland 
Ralph  Finch  Brown,  New  Jersey 
Alfred  George  Bryant,  Connecticut 
Richard      Fairfax      Bundy,      Rhode 

Island 
Harry  William  Burns,  Vermont 
Charles  Robinson  Cannon,  Delaware 
Hollie    Eugene    Casstevens,     North 

Carolina 
Robert    Fleetwood    Darwin,     South 

Carolina 
Edward  Barrow  Denton,  Virginia 
Charles  Gordon  Dentry,  Jr.,  Mary- 
land 
Clyde  Kibler  Epting,  South  Carolina 
William  Feindt,  Jr.,  New  Jersey 
John  Reese  Funderburk,  South  Caro- 
lina 


Feliciano  Gonzalez,  New  York 
Charles  Thomas  Haile,  Maryland 
Thomas  Jesse  Harper,  South  Carolina 
Elmer  Eugene  Hobbs,  Maryland 
Guy  Stanley  Johnston,  Maine 
Burnell  Preston  Jones,  Virginia 
Bennie  Ross  Jones,  Maryland 
Walter  Edward  Lena,  Massachusetts 
John  Daniel  McLeod,  Alabama 
John  Abram  Magee,  New  York 
Thomas  Regan  Malone,  Maryland 
Roy  Patterson  May,  Pennsylvania 
William  Forest  Martin,  Maryland 
Albert  J.  Nathanson,  Maryland 
Harry  Alfred  Niles,  New  York 
H.  Leroy  Richards,  Connecticut 
Philip  Frebush  Schaffer,  West  Vir- 
ginia 
Everett  Laws  Smith,  North  Carolina 
Henry  Brown  Sowers,  Virginia 
George  O.  Via,  West  Virginia 
Charles  Victor  Wahlberg,  Connecti- 
cut 
Raymond  M.  Weidert,  Pennsylvania 
Anthony  C.  Winner,  New  York 
Matthew  G.  Welch,  New  York 
Harold  Richard  Wolfe,  West  Virginia 
Frank  E.  Woods,  West  Virginia 


Prizemen 

University  Prize,  Gold  Medal — Richard  F.  Bundy 
Honorable  Mention — Arthur  C.  Albert 


Doctor  of  Pharmacy 


Charles    Simimerfield     Austin,     Jr., 

Maryland 
James  Antonio  Barone,  New  York 
William  Arthur  Briggs,  Pennsylvania 
Homer  Cramer  Brooks,  Maryland 
Girdwood  CoUenberg,  Maryland 
Charles  D.  Eichelberger,  Maryland 
Arthur  Henry  Else,  New  Jersey 
Antonio  Feijo6,  Cuba 
Edwin  Hetz,  Maryland 
George  Karmann,  Maryland 


Frederick  A.  Lambrecht,  Maryland 
Russell  E.  Lee,  Virginia 
Earle  H.  Lightner,  Maryland 
Shadrach  W.  Lowe,  West  Virginia 
Mabel  Lee  Maginnis,  Maryland 
S.  Fred  Marshall,  Maryland 
Thomas  J.  Robinson,  West  Virginia 
Roy  B.  Schlosser,  Maryland 
Edwin  A.  Schmidt,  Maryland 
Li-Ta  Tong,  China 
G.  Ernest  Wolf   Maryland 


30  ITEMS 

Prizemen 

Gold  Medal  for  General  Excellence — S.  Fred  Marshall 
Simon  Prize  in  Practical  Chemistry — Arthur  H.  Eise 
Junior  Class — Honorable  Mention — E.  B.  Truitt 

Two  honorary  degrees  were  conferred,  the  degree  of  doctor  of 
science,  upon  Dr.  Ichigoro  Nakahara,  of  Japan,  who  has  visited 
Baltimore  in  the  interest  of  the  advancement  of  medical  science 
in  his  country,  and  the  degree  of  doctor  of  laws  upon  Dr.  William 
Simon,  of  Catonsville,  whose  chemical  researches  have  brought 
him  into  nation-wide  prominence. 

ITEMS 

Miss  Alice  Coulbourne,  University  Hospital  Training  School  for 
Nurses,  class  of  1914,  has  resigned  her  position  at  Bay  View  Hospital 
and  will  do  private  nursing,   ^he  is  located  at  1403  Madison  Avenue. 

Miss  Elva  Dean,  University  Hospital  Training  School  for  Nurses, 
class  of  1913,  who  has  been  superintendent  of  nurses  of  the  Cumber- 
land General  Hospital  Fayetteville,  N.  C.,^for  the  last  three  years, 
has  resigned  and  will  engage  in  private  nursing.  She  is  located  at 
1403  Madison  Avenue. 

The  twenty-second  annual  commencement  of  the  Training  School  for 
Nurses  of  the  University  Hospital  was  held  on  May  16,  at  Lehmann's 
Hall,  and  was  a  very  delightful  occasion.  The  graduates  in  their 
new  white  uniforms  looked  very  attractive  and  the  officials  in  their 
robes  of  office  added  academic  dignity  to  the  scene.  The  stage  was 
banked  with  beautiful  floral  gifts  to  the  graduates  and  the  hall  was 
tastefully  decorated.  ■  A  large  and  appreciative  audience  was  pres- 
ent, most  of  whom  remained  for  the  dance  that  followed. 

Programme 

Music 

Prayer,  Rev.  Arthur  B.  Kinsolving,  D.D. 

Music 

Address  to  the  graduates,  Arthur  M.  Shipley,  M.D. 

Music 

Address  by  Dr    Thomas  Fell,  Provost  of  the  University  of  Maryland. 
Conferring  of  Diplomas,   by  Randolph  Winslow,   A.M.,   M.D.,   LL.D. 


DEATHS  31 

Music 
Benediction 

Music 
Class  of  1916. 

Margaret  Dunn,  Maryland  Margaret  Colin  Mayo,  Maryland 

Julia  Irene  Kauffman,  Maryland  Bernice  Violet  Smith,  Maryland 

Marion  Asbury  Forney,  North  Caro-  Elsie  Love  Rutherford,  Virginia 

lina  Helen  Lambie  Blake,  Maryland 

Marguerite  Mary  Walter,  Maryland  Hildegarde  Reamy,  Virginia 

Sallie  Smith,  North  Carolina  Marie  Estell  Langenfeldt,  Maryland 

Laura  Polly  Clark,  North  Carolina  Nellie  Eureka  Dix,  Virginia 

Inez  May  Scarff,  Maryland  Elizabeth  Helen  Phelan,  Canada 

Anna  Spiller  Hurst,  Virginia  Mary  Edna  John,  Virginia 

Emma    Blanche    Hoffmaster,    Mary-  Julia  Louise  Henkel,  Virginia 

land  Lucy  DuLaney  Scaggs,  Maryland 

Lillie  Grace  Null,  Maryland  Lula  Kathryn  Eichner,  Maryland 

Helen  Bertielle  McSherry,  Maryland  Maud  Waring  Simmons,  South  Caro- 
Serena  Webster  Selfe,  Maryland  lina 

DEATHS 

Dr.  John  Rice  Fletcher,  College  of  Physicians  and  Surgeons, 
class  of  1891,  formerly  a  Fellow  of  the  American  Medical  Association; 
a  member  of  the  American  Academy  of  Ophthalmology  and  Oto- 
Laryngology,  and  American  Otological  Society  and  once  president 
of  the  Chicago  Laryngological  and  Otological  Society;  professor 
of  diseases  of  the  ear,  nose  and  throat  in  the  Chicago  Post-Graduate 
School,  died  at  his  home  in  Winnetka,  111  ,  April  28,  1916,  from 
pneumonia,  aged  51  years. 

Dr.  Millard  F.  Cockran,  University  of  Maryland  Medical  School, 
Class  of  1884,  of  Wilmington,  Del.;  a  member  of  the  Delaware 
State  Medical  Society,  died  in  the  Jefferson  Hospital,  Philadelphia, 
April  7,  1916,  from  hemorrhage  of  the  stomach  and  intestines,  aged 
57  years. 

Dr.  S.  W.  Stephenson,  Washington  School  of  Medicine  (merged 
with  P.  &  S.),  class  of  1873,  of  Mooresville,  N.  C,  for  over  forty 
years  a  practitioner  in  that  town,  and  one  of  the  most  prominent 
physicians  of  that  section  of  that  state,  died  at  his  home,  April  15, 
1916,  aged  72  years.     In  1875  when  Mooresville  was  a  village  of 


32  DEATHS 

only  three  dwellings  he  formed  a  partnership  with  Dr.  J.  H.  McLel- 
land  and  they  practiced  together  agreeably  until  Dr.  McLelland's 
death  only  a  few  years  ago.  He  represented  his  county  for  two 
terms  in  the  State  Legislature,  1901  and  1903. 

Dr.  William  Page  Mcintosh,  Surgeon,  U.  S.  P.  H.  S.,  P.  &  S., 
class  of  1882,  formerly  resident  physician  at  Bay  View  Hospital, 
died  at  his  home  Longwood,  Howard  County,  Maryland,  May  27, 
1916,  aged  61  years. 

Dr.  Mcintosh  was  born  near  Macon,  Harris  County,  Ga.,  June  14, 
1855.  His  father  was  Dr.  W.  E.  Mcintosh,  a  major  in  the  Con- 
federate Army  during  the  Civil  War.  Dr.  Mcintosh  received  a 
degree  at  West  Point  College,  near  his  father's  plantation;  then  was 
graduated  with  highest  honors  at  the  College  of  Physicians  and 
Surgeons  in  Baltimore. 

He  became  resident  physician  of  the  Maternity  Hospital.  After 
taking  a  special  course  at  Johns  Hopkins  University  he  was  ap- 
pointed resident  physician  of  Baj^iew  Asylum. 

Dr.  Mcintosh  was  considered  by  the  Public  Health  Service  one 
of  its  most  competent  men,  being  an  expert  on  smallpox,  yellow 
fever,  cholera  and  plague.  He  was  married  January  13,  1886,  to 
Miss  Isabel  Warfield  Stinson,  of  Catonsville,  Md.  Surviving  him  are 
his  widow  and  three  children,  Dr.  William  Page  Mcintosh,  Jr., 
Mrs.  Wilham  H.  Walsh  and  Mrs.  R.  S.  Pindeel. 

Dr.  Mcintosh  spent  his  last  few  years  on  his  farm,  Longwood. 

He  was  a  Knight  Templar  and  a  member  of  the  Shrine,  a  fellow 
of  the  American  Medical  Association,  member  of  the  Association  of 
Military  Surgeons  and  many  other  medical  societies. 

Dr.  Joseph  S.  Baldwin,  University  of  Maryland  Medical  School, 
class  of  1874  of  Freeland,  Baltimore  County,  Md.;  Health  Officer 
of  the  Sixth  District  of  Baltimore  County,  died  at  his  home,  May  6, 
1916,  aged  70  years. 

Dr.  Henry  L.  Donsife,  University  of  Maryland  ]\ledical  School, 
class  of  1864,  of  Woodsboro,  Md.,  at  one  time  a  prominent  physician 
of  Frederick,  Md.,  died  at  the  Montevue  Hospital,  May  10,  1916, 
as  the  result  of  being  scalded  in  a  bathtub,  aged  73  years. 


BULLETIN 

OF  THE 

University  of  Maryland  School 
OF  Medicine 

AND 

College  of  Physicians  and 
Surgeons 

Successor  to  The  Hospital  Bulletin,  of  the  University  of  Maryland, 
Baltimobe  Medical  College  News,  and  the  Journal  of  the  Alumni  Asso- 
ciation of  the  College  of  Physicians  and  Surgeons. 

Vol.  I  JULY,  1916  .  No.  2 


ANNUAL  ANNOUNCEMENT 

SESSION  1916-1917 


CALENDAR. 


1916-17 


June  1  to  September  30. — Daily  Clinics  at  University,  Mercy,  and 
Maryland  General  Hospitals. 

September  25. — Examination  of  Conditioned  Students  and  Exami- 
nation for  Advanced  Standing. 

October  2. — Regular  Session  begins. 

November  29. — Thanksgiving  Recess  begins.     6  p.m. 

December  4.— Thanksgiving  Recess  ends.     9  a.m. 

December  22.— Christmas  Recess  begins.     6  p.m. 

January  3. — Christmas  Recess  ends.     9  a.m. 

April  5. — Easter  Recess  begins.     6  p.m. 

Apri   10. — Easter  Recess  ends.     9  a.m. 

June  4. — Commencement. 


DEPARTMENTS 

OF  THE 

UNIVERSITY  OF  MARYLAND. 


THE  UNIVERSITY  is  represented  by  five  departments,  each 
having  a  distinct  Faculty  of  Instruction. 

1st.  The  College  of  Liberal  Arts  at  Annapolis  Md.  St. 
John's  College,  Annapolis,  Md.,  founded  in  1696,  has  by  affiliation 
become  the  Department  of  Arts  and  Sciences.  The  curriculum  leads 
to  the  degree  of  Bachelor  of  Arts  or  Science. 

2d.  The  School  of  Medicine  in  Baltimore,  Md.  The  Univer- 
sity of  Maryland  was  established  in  Baltimore  in  1807;  The  College 
of  Physicians  and  Surgeons  was  established  in  Baltimore  in  1872. 
The  consolidated  school  offers  a  high  grade  course  in  medicine  ex- 
tending over  a  period  of  four  years,  and  leading  to  the  degree  of 
Doctor  of  Medicine. 

3d.  The  School  OF  Law  in  Baltimore,  Md.  This  school,  founded 
in  1812  and  reorganized  in  1869,  is  designed  by  means  of  a  course  of 
study  covering  three  years  to  qualify  its  students  for  the  degree  of 
Bachelor  of  Laws  and  for  an  intelligent  practice  of  the  Law. 

4th.  The  School  of  Dentistry  in  Baltimore,  Md.,  was  founded 
in  1882,  and  is  designed  to  teach  the  art  of  dentistry  as  an  integral 
part  of  the  School  of  Medicine.  The  course  of  study  leading  to  the 
degree  of  Doctor  of  Dental  Surgery  covers  a  period  of  three  years. 

5th.  The  School  of  Pharmacy  in  Baltimore,  Md.,  was  estab- 
lished in  1841  as  the  Maryland  College  of  Pharmacy,  and  affiliated 
with  the  School  of  Medicine  in  1904.  The  course  of  study  covers 
two  years,  and  leads  to  the  degree  of  Graduate  in  Pharmacy. 

3 


BOARD  OF  REGENTS 

OF  THE 

UNIVERSITY  OF  MARYLAND. 

Thomas  Fell,  Ph.D.,  LL.D.,  D.C.L.,  Provost. 


Randolph  Winslow,  A.M.,  M.D., 

LL.D. 
Henhy  D.  Harlan,  LL.D. 
L.  E.  Neale,  M.D.,  LL.D. 
J.  Holmes  Smith,  M.D. 
John  C.  Rose,  LL.B.,  LL.D. 
D.  M.  R.  Culbreth,  A.m.,  M.D. 
John  C.  Hemmeter,  M.D.,  Ph.D., 

LL.D. 
Charles  Caspari,  Jr.,  Phar.D. 
Daniel  Base,  Ph.D. 
Henry  P.  Hynson,  Phar.D. 
Henry  Stockbridge,  LL.D. 
Philemon  H.  Tuck,  A.M.,  LL.B. 
Arthur  M.  Shipley,  M.D. 
T.  O.  Heatwole,  M.D.,  D.D.S. 


L  H.  Davis,  M.D.,  D.D.S. 

Robert  Moss,  Esq. 
Samuel  K.  Merrick,  M.D. 
Ridgely  B.  Warfield,  M.D. 
William  L.  R.-vwls,  Esq. 
Randolph  Barton,  Jr.,  A.B.,  LL.B. 
Alfred  S.  Niles,  A.B.,  A.M.,  LL.B, 
John  W.  Chambers,  M.D.,  Sc.D. 
William  F.  Lockwood,  M.D. 
George  W.  Dobbin,  A.B.,  M.D. 
Harry  Friedenwald,  A.B.,  M.D. 
Archibald  C.  H.\rrison,  M.D. 
Gary  B.  Gamble,  Jr.,  A.M.,  M.D. 
William  S.  Gardner,  M.D. 
Standish  McCleary,  M.D. 


THE  UNIVERSITY  COUNCIL. 

The  duty  of  this  council  is  to  formulate  the  scheme  of  studies  to  be  pursued 
by  students  desiring  both  an  academic  and  a  professional,  or  scientific  degree, 
and  to  act  upon  such  other  matters  as  may  be  brought  l^efore  them. 

The  Chancellor, 

HON.  EMERSON  C.  HARRINGTON, 

Governor  of  Maryland. 

TJie   Provost, 

THOMAS  FELL,  Ph.D.,  LL.D.,  D.C.L., 

President  of  St.  John's  College. 

J.  B.  RIPPERE,  A.iM., 

PHILEMON  H.  TUCK,  A.M.,  LL.D., 

For  St.  John's  College. 

RANDOLPH   WINSLOW,    A.M.,    M.D.,    LL.D 

WM.  F.  LOCKWOOD,  M.D.. 

For  School  of  Medicine. 

HENRY  D.  HARLAN,  LL.D., 

HENRY  STOCKBRIDGE,  LL.D., 

For  School  of  Law. 
T.  O.  HEATWOLE,  M.D.,  D.D.S., 

For  School  of  Dentistry. 

CHARLES  CASPARI,  Jr.,  Phar.D., 

For  School  of  Pharmacy. 

4 


UNIVERSITY  OF  MARYLAND, 
SCHOOL  OF  MEDICINE 

FOUNDED  180r. 

COLLEGE  OF  PHYSICIANS  AND 
SURGEONS. 

FOUNDED   1872. 


FACULTY  OF  PHYSIC. 

RANDOLPH  WINSLOW,  A.M.,  M.D.,  LL.D. 
L.  E.  NEALE,  M.D.,  LL.D. 
CHARLES  W.  MITCHELL,  A.M.,  M.D. 
J.  HOLMES  SMITH,  M.D. 

JOHN  C.  HEMMETER,  M.D.,  Ph.D.,  Sc.D.,  LL.D. 
ARTHUR  M.  SHIPLEY,  M.D. 
SAMUEL  K.  MERRICK,  M.D. 
RIDGELY  B.  WARFIELD,  M.D. 
GORDON  WILSON,  M.D. 
JOHN  W.  CHAMBERS,  M.D.,  Sc.D. 
WILLIAM  F.  LOCKWOOD,  M.D. 
GEORGE  W.  DOBBIN,  A.B.,  M.D. 
WILLIAM  ROYAL  STOKES,  M.D.,  Sc.D, 
HARRY  FRIEDENWALD,  A.B.,  M.D. 
ARCHIBALD  C.  HARRISON,  M.D. 
GARY  B.  GAMBLE,  Jr.,  A.M.,  M.D. 
WILLIAM  S.  GARDNER,  M.D. 
STANDISH  McCLEARY,  M.D. 
JULIUS  FRIEDENWALD,  A.M.,  M.D 
J.  M.  H.  ROWLAND,  M.D. 
HIRAM  WOODS,  A.M.,  M.D. 
CHARLES  E.  SIMON,  A.B.,  M.D. 
5 


BOARD  OF  INSTRUCTION. 

Randolph  Winslow,  A.M.,  M.D.,  LL.D.,  Professor  of  Surgery. 

L.  E.  Neale,  M.D.,  LL.D.,  Professor  of  Obstetrics. 

Charles  W.  Mitchell,  A.M.,  M.D.,   Professor  of  Pediatrics  and  Clinical 

Medicine. 
J.  Holmes  Smith,  M.D.,  Professor  of  Anatomy. 
John  C.  Hemmetbr,  M.D.,  Ph.D.,  Sc.D.,  LL.D.,  Professor  of  Phj^siology  and 

Clinical  Medicine. 
Arthur  M.  Shipley,  M.D.,  Professor  of  Surgery. 

Samuel  K.  Merrick,  M.D.,  Professor  of  Diseases  of  the  Throat  and  Nose. 
RiDGELY  B.  Warfield,  M.D.,  Professor  of  Surgery. 
Gordon  Wilson,  M.D.,  Professor  of  Medicine. 

William  Simon,  Ph.D.,  M.D.,  Sc.D.,  Emeritus  Professor  of  Chemistry. 
John  W.  Chambers,  M.D.,  Sc.D.,  Professor  of  Surgery. 
Nathaniel  G.  Keirle,  A.M.,   M.D.,   Sc.D.,   LL.D.,   Professor  of  Medical 

Jurisprudence. 
WILLIAM  F.  LocKwooD,  M.D.,  Professor  of  Medicine. 

George  W.  Dobbin,  A.B.,  M.D.,  Professor  of  Obstetrics  and  Gynecology. 
William  Royal  Stokes,  M.D.,  Sc.D.,  Professor  of  Pathology  and  Bacteri- 
ology. 
Harry  Friedenwald,  A.B.,  M.D.,  Professor  of  Ophthalmology  and  Otology. 
Archibald  C.  Harrison,  M.D.,  Professor  of  Surgery. 
Gary  B.  Gamble,  Jr.,  A.M.,  M.D.,  Professor  of  Medicine. 
William  S.  Gardner,  M.D.,  Professor  of  Gynecology. 
Standish  McCleary,  ]\LD.,  Professor  of  Pathology. 
Julius  Friedenwald,  A  M.,  M.D.,  Professor  of  Gastro-Enterology.  . 
T.  M.  H.  Rowland,  M.D.,  Professor  of  Obstetrics  and  Dean  of  the  Faculty. 
Hiram  Woods,  A.M.,  M.D.,  Professor  of  Ophthalmology  and  Otology. 
Charles  E.  Simon,  A.B.,  M.D.,  Professor  of  Physiological  Chemistry  and 

Clinical  Pathology. 
Ernest  Zueblin,  M.D.,  Professor  of  Experimental  and  Clinical  Medicine. 
Jose  L.  Hirsh,  A.B.,  M.D.,  Professor  of  Clinical  Pediatrics. 
John  S.  Fulton,  A.B.,  M.D.,  Professor  of  State  Medicine. 
Harry  Adler,  A.B.,  M.D.,  Professor  of  Clinical  Medicine. 
Thomas  C.  Gilchrist,  M.R.C.S.,  L.S.A.,  M.D.,  Professor  of  Dermatology. 
Frank  Martin,  B.S.,  M.D.,  Professor  of  Clinical  and  Operative  Surgery. 
Charles  G.  Hill,  A.AL,  INLD.,  Professor  of  Psychiatr3\ 
A.  C.  Pole,  M.D.,  Professor  of  Descriptive  Anatomy. 
J.  D.  Blake,  M.D.,  Professor  of  Clinical  Surgery. 

J.  Frank  Crouch,  M.D.,  Professor  of  Clinical  Opthalmology  and  Otology. 
Charles  O'Donovan,  A.ISL,  M.D.,  LL.D.,  Professor  of   Clinical  Medicine 

and  Pediatrics. 
G.  Milton  Linthicum,  A.]\L,  M.D.,  Professor  of  Diseases  of  the  Rectum  and 

Colon. 

6 


BOARD    OF    INSTRUCTION  7 

W.  B.  Perry,  M.D.,  Professor  of  Clinical  Gynecology. 

TiLGiiMAN  B.  Marden,  A.B.,  M.D.,  Professor  of  Histology  and  F>mbryology. 

J.  Mason  Hundley,  M.D.,  Professor  of  Clinical  Gynecology. 

Joseph  T.  Smith,  M.D.,  Professor  of  Hygiene. 

R.  TuNSTALL  Taylor,  A.B.,  M.D.,  Professor  of  Orthopedic  Surgery. 

John  R.  Winslow,  A.B.,  M.D.,  Professor  of  Diseases  of  the  Throat  and  Nose. 

J.  M.  Craighill,  M.D.,  Professor  of  Clinical  Medicine. 

Jos.  E.  Gichner,  M.D.,  Professor  of  Clinical  Medicine  and  Physical  Thera- 
peutics. 

Charles  W.  McElfresh,  M.D.,  Professor  of  Clinical  Medicine. 

Irving  J.  Spear,  M.D.,  Professor  of  Neurology  and  Clinical  Psychiatry. 

Jas.  a.  Nydegger,  A.m.,  M.D.,  Sc.D.,  Surg.  V.  S.  P.  H.  Service,  Professor  of 
Tropical  Medicine. 

Edward  N.  Brush,  M.D.,  Professor  of  Psychiatry. 

C.  Hampson  Jones,  M.B.,  CM.  (Edinburgh),  M.D.,  Professor  of  Hygiene  and 
Public  Health. 

John  Ruhrah,  M.D.,  Professor  of  Pediatrics. 

Charles  F.  Blake,  A.M.,  M.D.,  Professor  of  Proctology. 

Frank  Dyer  Sanger,  M.D.,  Professor  of  Diseases  of  Throat  and  Nose. 

Bartgis  McGlone,  A.B.,  Ph.D.,  Professor  of  Physiology. 

G.  Carroll  Lockard,  M.D.,  Professor  of  Clinical  Medicine  and  Clinical 
Pediatrics. 

Samuel  J.  Fort,  M.D.,  Professor  of  Materia  Medica  and  Pharmacology. 

Charles  E.  Brack,  Ph.G.,  M.D.,  Professor  of  Clinical  Obstetrics. 

Harvey  G.  Beck,  M.D.,  D.Sc.    Professor  of  Clinical  Medicine. 

Albertus  Cotton,  A.M.,  M.D.,  Professor  of  Orthopedic  Surgery  and  Roent- 
genology. 

Alexius  McGlannan,  A.M.,  M.D.,  Professor  of  Clinical  Surgery  and  Surgical 
Pathology. 

Andrew  C.  Gillis,  A.M.,  M.D.,  Professor  of  Neurology  and  Clinical  Psychia- 
try. 

Joseph  H.  Branham,  M.D.,  Professor  of  Clinical  Surgery. 

Pearce  Kintzing,  M.D.,  Professor  of  Clinical  Medicine. 

Albert  T.  Chambers,  M.D.,  Professor  of  Clinical  Surgerj'. 

Bernard  Purcell  Muse,  M.D.,  Professor  of  Clinical  Obstetrics. 

John  G.  Jay,  M.D.,  Clinical  Professor  of  Surgery. 

Nathan  Winslow,  A.M.,  M.D.,  Clinical  Professor  of  Surgery. 

Page  Edmunds,  M.D.,  Clinical  Professor  of  Genito-Urinary  Diseases. 

Wm.  Tarun,  M.D.,  Clinical  Professor  of  Ophthalmology  and  Otology. 

Alfred  Ullman,  M.D.,  Clinical  Professor  of  Surgery. 

Walter  D.  Wise,  M.D.,  Clinical  Professor  of  Surgery. 

Edgar  B.  Friedenwald,  M.D.,  Clinical  Professor  of  Pediatrics. 

Compton  Riely,  M.D.,  Clinical  Professor  of  Orthopedic  Surgery. 

Sydney  M.  Cone,  A.B.,  M.D.,  Clinical  Professor  of  Orthopedic  Surgery. 

W.  S.  Smith,  M.D.,  Clinical  Professor  of  Gynecology. 

Joseph  W.  Holland,  M.D.,  Associate  Professor  of  Anatomy  and  Clinical 
Surgery. 

E.  B.  Freeman,  B.S.,  M.D.,  Associate  Professor  of  Gastro-Enterology. 


8  BOARD    OF    INSTRUCTION 

H.  R.  Spencer.  M.D.,  Associate  Professor  of  Pathology  and  Bacteriology. 

E.  R.  Strobel,  A.B.,  M.D.,  Associate  Professor  of  DermatologJ^ 

W.  B.  Wolf,  M.D.,  Associate  Professor  of  Genito-Urinary  Diseases. 

Thomas  W.  Keown,  A.B.,  M.D.,  Associate  Professor  of  Clinical  Medicine. 

J.  Clement  Clark,  M.D.,  Associate  Professor  of  Psychiatry. 

Hugh  Brent,  M.D.,  Associate  Professor  of  Gynecology. 

Wm.  I.  Messick,  M.D.,  Associate  Professor  of  Clinical  Medicine. 

HoLLiDAY  H.  Hayden,  M.D.,  Associate  Professor  of  Applied  Anatomy. 

Melvin  Rosenthal,  M.D.,  Associate  Professor  of  Genito-Urinary  Surgery 
and  Dermatology. 

Hubert  C.  Knapp,  M.D.,  Associate  Professor  of  Medicine. 

Abraham  Samuels,  Ph.G.,  M.D.,  Associate  Professor  of  Gynecology. 

William  W.  Requardt,  M.D.,  Associate  Professor  of  Surgery. 

Caleb  W.  G.  Rohrer,  A.M.,  M.D.,  Ph.D.,  Associate  Professor  of  Pathology. 

Glenn  M.  Litsinger,  A.B.,  M.D.,  Associate  Professor  of  Obstetrics. 

George  W.  Mitchell,  M.D.,  Associate  Professor  of  Diseases  of  Throat  and 
Nose. 

G.  Howard  White,  A.B.,  M.D.,  Associate  Professor  of  Physiological  Chem- 
istry and  Clinical  Pathology. 

Lewis  J.  Rosenthal,  M.D.,  Associate  Professor  of  Proctology. 

J.  R.  Abercrombie,  A.B.,  M.D.,  Associate  Professor  of  Dermatology. 

Wm.  Greenfeld,  M.D.,  Associate  Professor  of  Pathology  and  Bacteriology. 

C.  C.  CoNSER,  M.D.,  Associate  Professor  of  Physiology. 

H.  J.  Maldeis,  M.D.,  Associate  Professor  of  Clinical  Pathology  and  Patholo- 
gist to  University  Hospital. 

A.  H.  Carroll,  M.D.,  Associate  Professor  of  Gastro-Enterology. 

J.  Dawson  Reeder,  M.D.,  Associate  Professor  of  Proctology. 

E.  F.  Kelly,  Phar.D.,  Associate  Professor  of  Chemistry. 

J.  C.  Lumpkin,  M.D.,  Associate  Professor  of  Clinical  Surgery. 

H.  C.  Blake,  M.D.,  Associate  Professor  of  Clinical  Surgery. 

A.  J.  Underbill,  A.B.,  M.D.,  Associate  Professor  of  Genito-Urinary  Diseases. 

Robert  P.  Bay,  M.D.,  Associate  Professor  of  Clinical  Surgery. 

Frank  S.  Lynn,  M.D.,  Associate  Professor  of  Surgery. 

G.  M.  Settle,  A.B.,  M.D.,  Associate  Professor  of  Neurology  and  Clinical 
Medicine. 

H.  Boyd  Wylie,  M.D.,  Associate  Professor  of  Pharmacology  and  Physiologi- 
cal Chemistry. 

T.  Fred  Leitz,  M.D.,  Associate  Professor  of  Gastro-Enterology. 

Anton  G.  Rytina,  A.B.,  M.D.,  Associate  Professor  of  Genito-Urinary  Dis- 
eases. 

C.  C.  W.  Judd,  A.B.,  M.D.,  Associate  Professor  of  Medicine. 

Elliott  H.  Hutchins,  A.B.,  M.D.,  Associate  Professor  of  Surgery. 

Thomas  R.  Chambers,  A.B.,  M.D.,  Associate  Professor  of  Surgery. 

Harvey  B.  Stone,  A.B.,  M.D.,  Associate  Professor  of  Surgery. 

R.  W.  Locher,  M.D.,  Associate  Professor  of  Operative  and  Clinical  Surgery. 

J.  K.  B.  E.  Seegar,  M.D.,  Associate  Professor  of  Obstetrics. 

Emil  Novak,  M.D.,  Associate  Professor  of  Obstetrics. 

H.  C.  Davis,  M.D.,  Associate  Professor  of  Diseases  of  the  Throat  and  Nose. 


BOARD    OF    INSTRUCTION 

S.  Griffith  Davis,  A.B.,  M.D.,  Associate  Professor  of  Anaesthesia. 

Wm.  H.  Smith,  M.D.,  Associate  in  Clinical  Medicine. 

H.  E.  Petkrman,  M.D.,  Associate  in  Ophthalmology  and  Otology. 

E.  H.  Hayward,  M.D.,  Associate  in  Gynecology. 

J.  L.  Wright,  M.D.,  Associate  in  Anatomy  and  Histology. 

Clyde  A.  Clapp,  M.D.,  Associate  in  Ophthalmology  and  Otology. 

J.  E.  PouLTON,  M.D.,  Associate  in  Pediatrics. 

J.  Percy  Wade,  M.D.,  Associate  in  Psychiatry. 

G.  W.  Hemmeter,  M.D.,  Associate  in  Physiology. 

H.  L.  Sinskey,  M.D.,  Associate  in  Materia  Medica. 

H.  W.  Stoner,  M.D.,  Associate  in  Pathology  and  Bacteriology. 

R.  C.  Metzel,  M.D.,  Associate  in  Clinical  Medicine. 

H.  D.  McCarty,  M.D.,  Associate  in  Clinical  Medicine. 

Wilbur  P.  Stubbs,  M.D.,  Associate  in  Clinical  Medicine. 

John  E.  O'Neill,  M.D.,  Associate  in  Clinical  Medicine. 

L.  W.  Ketron,  A.B.,  M.D.,  Associate  in  Dermatology. 

Geo.  a.  Strauss,  Jr.,  M.D.,  Associate  in  Gynecology. 

H.  K.  Fleckenstein,  M.D.,  Associate  in  Ophthalmology  and  Otology. 

Maurice  Lazenby,  M.D.,  Associate  in  Obstetrics. 

W.  Milton  Lewis,  M.D.,  Associate  in  Clinical  Pathology. 

Joseph  I.  Kemler,  M.D.,  Associate  in  Ophthalmology  and  Otology. 

F.  K.  Nichols,  A.B.,  M.D.,  Associate  in  Phj'siology. 
Henry  T.  Collenberg,  A.B.,  M.D.,  Associate  in  Physiology. 
Frank  W.  Hachtel,  M.D.,  Associate  in  Bacteriology. 

G.  F.  Sargent,  M.D.,  Associate  in  Neurology  and  Clinical  Psychiatry. 
George  Murgatroyd,  M.D.,  Associate  in  Diseases  of  the  Throat  and  Nose. 
Arthur  G.  Barrett,  M.D.,  Associate  in  Surgery. 

Frank  J.  Kirby,  M.D.,  Associate  in  Surgery. 

Fred.  Rankin,  A.M.,  M.D.,  Associate  in  Surgery. 

H.  S.  Gorsuch,  M.D.,  Associate  in  Obstetrics. 

J.  Harry  Ullrich,  M.D.,  Associate  in  Gastro-Enterology. 

H.  J.  Walton,  M.D.,  Associate  in  Roentgenology. 

Wm.  C.  Stifler,  M.D.,  Associate  in  Diseases  of  the  Throat  and  Nose. 

Wm.  Caspari,  M.D.,  Associate  in  Diseases  of  the  Throat  and  Nose. 

J.  Wesley  Cole,  M.D.,  Associate  in  Medicine. 

J.  W.  Downey,  M.D.,  Associate  in  Otology. 

J.  McF.  Bergland,  M.D.,  Associate  in  Obstetrics. 

B.  M.  Bernheim,  A.B.,  M.D.,  Lecturer  on  Blood-Vessel  Surgery. 

Frank  W.  Keating,  M.D.,  Lecturer  on  Psycho-Asthenics. 

W.  P.  E.  Wyse,  M.D.,  Lecturer  on  Psychiatry. 

G.  A.  Fleming,  M.D.,  Demonstrator  of  Ophthalmology  and  Otology. 

H.  U.  Todd,  M.D.,  Demonstrator  of  Clinical  Pathology. 

G.  S.  M.  Ivieffer,  M.D.,  Demonstrator  of  Medicine. 

J.  T.  O'Mara,  M.D.,  Demonstrator  of  Medicine. 

R.  G.  Willse,  M.D.,  Demonstrator  of  Gynecology. 

Harry  M.  Robinson,  M.D.,  Demonstrator  of  Dermatology. 

S.  H.  Street,  B.S.,  M.D.,  Demonstrator  of  Gynecology. 

W.  H.  Daniels,  M.D.,  Demonstrator  of  Orthopedic  Surgery. 


10  BOARD    OF    INSTRUCTION 

B.  S.  Haxxa,  M.D.,  Demonstrator  of  Clinical  Pathology. 
J.  F.  Hawkins,  M.D.,  Instructor  in  Neurology. 

W.  K.  White,  M.D.,  Instructor  in  Gynecology. 

R.  L.  Mitchell,  M.D.,  Instructor  in  Gj'nccology. 

Milton  P.  Hill,  M.D.,  Instructor  in  Neurology. 

Christian  Deetjen,  M.D.,  Instructor  in  Roentgenology. 

L.  H.  DouGL.vs,  M.D.,  Instructor  in  Gynecology  and  Obstetrics. 

Edward  A.  Looper,  M.D.,  D.Oph.,  Instructor  in  Ophthalniologj'  and  Otology. 

Ernest  G.  Marr,  M.D.,  Instructor  in  Diseases  of  the  Rectum  and  Colon. 

Howard  D.  Lewis,  ]\I.D.,  Instructor  in  Surgery. 

Sam'l.  W.  Moore,  D.D.S.,  Instructor  in  Anaesthesia. 

Benjamin  Pushkin,  M.D.,  Instructor  in  Neurology. 

F.  L.  Jennings,  M.D.,  Instructor  in  Surgery. 

D.  D.  V.  Stuart,  Jr.,  M.D.,  Instructor  in  Neurology  and  Clinical  Psychiatry. 
John  Evans,  M.D.,  Instructor  in  Roentgenology. 

H.  N.  Freeman,  M.D.,  Instructor  in  Obstetrics. 

J.  V.  Culverhouse,  M.D.,  Instructor  in  Anaesthesia. 

C.  W.  Rauschenbach,  M.D.,  Instructor  in  Medicine. 
Wm.  R.  Geraghty,  IM.D.,  Instructor  in  Anatomy. 

E.  E.  Mayer,  M.D.,  Instructor  in  Medicine. 
J.  M.  Fenton,  ]\I.D.,  Assistant  in  Gynecology. 
J.  E.  Brumback,  M.D.,  Assistant  in  Medicine. 
J.  D.  BuBERT,  M.D.,  Assistant  in  Surgery. 
John  S.  Fenby,  M.D.,  Assistant  in  Pediatrics. 

C.  Reid  Edwards,  M.D.,  Assistant  in  Orthopedic  Surgery. 

J.  G.  Stiefel,  M.D.,  Assistant  in  Gastro-Enterology. 

R.  D.  West,  M.D.,  Assistant  in  Ophthalmology  and  Otology. 

M.  L.  LiCHTENBERG,  M.D.,  Assistaut  in  Diseases  of  the  Throat  and  Nose. 

A.  M.  Evans,  M.D.,  Assistant  in  Surgery. 

E.  Le  Compte  Cook,  JNI.D.,  Assistant  in  Medicine. 
L.  M.  C.  Parker,  M.D.,  Assistant  in  Medicine. 
Frank  J.  Powers,  M.D.,  Assistant  in  Medicine. 
O.  V.  Linhard,  M.D.,  Assistant  in  Medicine. 

F.  E.  Shipley,  M.D.,  Assistant  in  Medicine. 
Charles  B.  Wheltle,  M.D.,  Assistant  in  Medicine. 
J.  W.  V.  Clift,  M.D.,  Assistant  in  Medicine. 

Wm.  B.  Schapiro,  M.D.,  Assistant  in  Obstetrics. 
Wm.  a.  Boyd,  B.S.,  M.D.,  Assistant  in  Neurology. 


UNIVERSITY     HOSPITAL    STAFF  11 

UNIVERSITY    HOSPITAL    STAFF 

ALlending  Surgeons. 

Randolph  Winslovv,  A.M.,  M.D.,  LL.D.        John  D.  Blake,  M.D. 
Arthur  M.  Shipley,  M.D.  Nathan  Winslow,  A.M.,  M.D. 

Frank  Martin,  B.S.,  M.D.  J.  W.  Holland,  M.D. 

RiDGELY  B.  Warfield,  M.D.  R.  P.  Bay,  M.D. 

Atlendiny  Physicians. 

Charles  W.  Mitchell,  A.M.,  M.D.  J.  M.  Craighill,  M.D. 

John  C.  Hemmeter,  Ph.D.,  M.D.  Jos.  E.  Gichner,  M.D. 

Gordon  Wilson,  M.D.  Charles  W.  McElfresh,  M.I), 

Harry  Adler,  A.B.,  M.D.  G.  Carroll  Lockard,  M.D. 

Charles  O' Donovan,  A.M.,  M.D. 

.■itlending  Gynecologists. 
J.  Mason  Hundley,  M.D.  W.  P.  Perry,  M.D. 

.\tlending  Obstetricians. 
L.  E.  Neale,  M.D.,  LL.D.  J.  M.  H.  Rowland,  .M.D. 

Attending  Ophtli  limoiogists. 
Hiram  Woods,  A.M.,  M.D.  J.  Frank  Crouch,  M.D. 

Attending  Laryngologists. 
John  R.  Winslow,  A.B.,  M.D.  Samuel  K.  Merrick,  A.B.,  M.D. 

Attending  Proctologists. 
G.  Milton  Linthicum,  A.M.,  M.D.  J.  Dawson  Reeder,  ALD. 

Attending   Orthopedic   Surgeons. 
R.  Tunstall  Taylor,  A.B.,  M.D.  Compton  Riely,  M.D. 

Attending  Neurologist. 
Irving  J.  Spear,  M.D. 

Attending  Genito-Urinary  Surgeons. 

Gideon  Timberlake,  M.D.  Page  Edmunds,  M.D. 

A.  J.  Underhill,  A.B.,  M.D. 

Attending  Pathologists. 

Wm.  Royal  Stokes,  M.D.,  Sc.D.  Standish  McCleary,  M.D. 

H.  J.  Maldeis,  M.D. 

Attending  Roentgenologist. 
H.  J.  Walton,  M.D. 


12  MERCY    HOSPITAL    STAFF 

RESIDENT  STAFF 

William  J.  Coleman,  Medical  Super irUendenl. 

Resident  Surgeons. 

W.  H.  TouLsoN,  M.S.,  M.D.  C.  P.  Ross,  M.D. 

C.  C.  Hoke,  A.M.,  M.D.  M.  J.  Egan,  M.D. 

J.  C.  Brogden,  A.B.,  M.D.  C.  A.  Reifschneidek,  M.D. 

Resident  Physicians. 

H.  M.  Stein,  M.D.  B.  J.  Ferky,  M.D. 

F.  C.  Marino,  M.D.  R.  H.  Folk,  A.B.,  M.D. 

J.  E.  Evans.  M.D. 

Resident  Gynecologist. 
C.  S.  Long,  M.D. 

Maternity  Department. 

J.  J.  Waff,  Chief  Resident  Obstetrician. 
W.  T.  Ferneyhough,  M.D.  _  T.  L.  Bray,  M.D. 

Pathologist. 
J.  T.  LuTz,  A.B.,  M.D. 


MERCY   HOSPITAL   STAFF. 
SURGICAL  DIVISION. 

Surgeons. 

John  W.  Chambers,  M.D.  Archibald  C.  Harrison,  M.D. 

Alexius  McGlannan,  M.D. 

Associate  Surgeons. 

Harvey  B.  Stone,  M.D.  William  W.  Requardt,  M.D. 

Elliott  H.  Hutchins,  M.D.  Walter  D.  Wise,  M.D. 

Alfred  Ulman,  M.D.  Thos.  R.  Chambers,  M.D. 

Ophthalmologist  and  Otologist. 
Harry  Friedenwald,  Al.D. 


MERCY    HOSPITAL    STAFF  1% 

Rhinologist  and  Laryngologist. 
Frank  D.  Sanger,  M.D. 

Associate  Rhinologist  and  Laryngologist. 
George  W.  Mitchell,  M.D. 

Proctologist. 
C.  F.  Blake,  M.D. 

Orthopedic  Surgeon. 
Albertus  Cotton,  M.D. 

Urologist. 
A.  G.  Rytina,  M.D. 


MEDICAL   DIVISION. 

Physicians. 

William  F.  Lockwood,  M.D.  Gary  B.  Gamble,  Jr.,  M.D. 

Standish  McClbary,  M.D. 

Associate  Physicians. 

Harvev  G.  Beck,  M.D.  Hubert  C.  Knapp,  M.D. 

C.  C.  W.  JuDD,  M.D.  Louis  J.  Rosenthal,  M.D. 

Gastro-Enterologist. 

Julius  Friedenwald,  M.D. 

Associate  Gastro-Enterologist. 
T.  Fredk.  Leitz,  M.D. 

Pediatrists. 
John  Ruhrah,  M.D.  Edgar  B.  Friedenwald,  M.D. 

Neurologist. 
Andrew  C.  Gillis,  M.D. 

Dermatologist. 
Melvin  Rosenthal,  M.D. 


14  MERCY    HOSPITAL    STAFF 

OBSTETRICAL   DIVISION. 

Obstetrician. 
George  W.  Dobbin,  M.D. 

Associate  Obstetricians. 

Charles  E.  Brack,  M.D.  Glenn  M.  Litsinger,  M.D. 

Emil  Novak,  M.D.  Maurice  Lazenby,  M.D. 


GYNECOLOGICAL  DIVISION. 

Gynecologist. 
William  S.  Gardner,  M.D. 

Associate  Gynecologists. 
Abraham  Samuels,  M.D.  George  Strauss,  M.I). 


PATHOLOGICAL  DIVISION. 

Pathologist. 
William  Royal  Stokes,  M.D. 

Associate  Pathologist. 
Standish  McCleary,  M.D. 


CLINICAL   PATHOLOGICAL   DIVISION. 

Clinical  Pathologist. 

Charles  E.  Simon,  M.D. 


DEPARTMENT  OF  OTO-NEUROLOGY. 
J.  W.  Downey,  Jr.,  M.D. 


J 


MERCY    HOSPITAL    STAFF  16 

X-RAY   DEPARTMENT. 

Radiographer. 
Albertus  Cotton,  M.D. 

Assistant  Radiographer. 
Humphrey  D.  Wolfe,  M.D. 


HOSPITAL  COMMITTEE. 

Archibald  C.  Harrison,  M.D.  William  F.  Lockwood,  M.D. 

Chairman.  William  S.  Gardner,  M.D. 
John  W.  Chambers,  M.D.  Secretary. 

Charles  F.  Blake,  M.D.  Cary  B.  Gamble,  M.D. 


RESIDENT  STAFF. 
E.  P.  Smith,  M.D.,  Superintendent. 

Resident  Surgeons. 

Richard  Shea,  M.D.  Ignatius  P.  A.  Byrne,  M.D. 

Raymond  W.  McKenzie,  M.D.  Guy  R.  Post,  M.D. 

Harry  L.  Rogers,  M.D.  Edward  Syrop,  M.D. 

David  M.  Airman,  M.D.  Humphrey  D.  Wolfe,  M.D. 

Resident  Physicians. 

Erwin  E.  Mayer,  M.D. 
T.  H.  Morrison,  M.D.  George  McLean,  M.D. 

Bartus  T.  Baggott,  M.D.  Arthur  F.  Peterson,  M.D. 

Resident  Gynecologist. 
Thomas  K.  Galvin,  M.D. 

Resident  Obstetrician. 
LuciEN  R.  Chaput,  M.D. 

.Accident  Service. 
H.  H.  Johnson,  M.D.  Lewis  H.  Howard,  M.D. 


16  MARYLAND    GENERAL    HOSPITAL    STAFF 

MARYLAND  GENERAL  HOSPITAL  STAFF. 
VISITING  STAFF. 

John  D.  Blake,  M.D.  Randolph  Winslow,  A.M.,  M.D.,  LL.D. 

RiDGELT  B.  Warfield,  M.D.  Arthur  M.  Shipley,  M.D. 

Frank  Martin,  B.S.,  M.D. 

Associates. 

J.  C.  Lumpkin,  M.D.  A.  G.  Barrett,  M.D. 

H.  C.  Blake,  M.D.  Nathan  Winslow,  A.M.,  M.D. 

J.    B.   CULVERHOUSE,  M.D. 

Physicians. 

E.  B.  Freeman,  M.D.  Charles  O'Donovan,  A.M.,  M.D.,  LL.D. 

A.  C.  Pole,  M.D.  Jno.  C.  Hemmeter,  M.D.,  Ph.D.,  Sc.D.,  LL  D. 

J.  W.  Cole,  M.D.  Harry  Adler,  A.B.    M.D. 

Gordon  Wilson,  M.D.  J.  M.  Craighill,  M.D. 

Jos.  E.  Gichner,  M.D. 

Associates. 

J.  E.  Poulton,  M.D.  L.  M.  G.  Parker,  M.D. 

Thomas  W.  Keown,  A.B.,  M.D.  Chas.  B.  Wheltle,  M.D. 

Frank  J.  Powers,  M.D.  J.  W.  Clift,  M.D. 

O.  V.  Linhardt,  M.D. 

Neurologists. 
Chas.  G.  Hill,  A.M.,  M.D.  Irving  J.  Spear,  M.D. 

Associates. 

J.  Clement  Clark,  M.D.  J.  Percy  Wade,  M.D. 

W.  P.  E.  Wyse,  M.D. 

Laryngologists. 
S.  K.  Merrick,  M.D.  John  R.  Winslow,  .\.B.,  M.D. 

Obstetricians. 
J.  M.  H.  Rowland,  M.D.  L.  E.  Neale,  M.D.,  LL.D. 

Associates. 

J.  K.  B.  Seegar,  M.D.  Stanley  H.  Gorsuch,  M.D. 

H.  N.  Freeman,  M.D. 

Gynecologists. 
W.  B.  Perry,  M.D.  J.  Mason  Hundley,  M.D. 


MARYLAND    GENERAL    HOSPITAL    STAFF  17 

Associates. 
S.  H.  Streett,  B.S.,  M.D.  Maurice  Lazenby,  M.D. 

J.  M.  Fenton,  M.D.  E.  H.  Hayward,  M.D. 

Ophthalmologists. 
J.  Frank  Crouch,  M.D.  Hiram  Woods,  A.M.,  M.D. 

Associates. 

Clyde  A.  Clapp,  M.D.  R.  D.  West,  M.D. 

H.  E.  Peterman,  M.D. 

Proctologists. 
G.  Milton  Linthicum,  A.M.,  M.D. 

Associate. 
Ernest  G.  Mark,  M.D. 

Radiologist. 
John  Evans.  M.D. 

Dermatologist. 
E.  R.  Stroebel,  A.B.,  M.D. 

Urologist. 
W.  B.  Wolf,  M.D. 

Orthopedic  Surgeon. 
Sidney  M.  Cone,  A.B.,  M.D. 

Pathologists. 

Wm.  Royal  Stokes,  M.D.,  Sc.D.  Standish  McCleary,  M.D. 

H.  W.  Stoner,  M.D.  H.  B.  Wylie,  M.D. 

Anaesthetist. 

J.  B.  Culverhouse,  M.D. 
Elmer  Newcomer,  M.D.,  Medical  Superintendent. 


RESIDENT  STAFF. 


G.  A.  Bawden,  M.D.  W.  H.  Sloan,  M.D. 

B.  H.  Lovely,  M.D.  B.  M.  Jaffe,  M.D. 

G.  R.  Patrick,  M.D.-  H.  Goldman,  M.D. 

D.  C.  Button,  M.D.  B.  H.  Growt,  M.D. 
F.  P.  Nicholson,  M.D. 


IS  KERNAN    HOSPITAL    STAFF 

THE  JAMES  LAWRENCE  KERNAN  HOSPITAL  AND  INDUSTRIAL 
SCHOOL   OF   MARYLAND    FOR   CRIPPLED    CHILDREN. 

R.  TuNSTALL  Taylor,  A.B.,  M.D.,  Surgeon-in-Chief. 

Associate  Surgeons. 
Sydney  M.  Cone,  A.B.,  M.D.  Albertus  Cotton,  A.M.,  M.D. 

COMPTON  RiELY,  M.D. 

W.  H.  Daniels,  M.D.,  Dispensary  Surgeon  and  Anaesthetist. 

C.  Reid  Edwards,  M.D.,  Assistant  Surgeon  and  Superintendent. 

Louis  A.  Buie,  A.B.,  M.D.,  Resident  Surgeon. 

Caroline  H.  Barney,  R.N.,  Head  Nurse. 

Miss  Anita  Renshaw  Presstman,  Instructor  in  Corrective  Gymnastics. 

Miss  Mary  H.  Lee,  Principal  of  School. 

Miss  Ada  Mosby,  Kindergartner  and  Industrial  Teacher. 

Roentgenologist. 
Henry  J.  Walton,  M.D. 

Attending  Plastic  Surgeon. 
John  Staige  Davis,  B.Sc,  M.D. 

Attending  Physician.    . 
A.  D.  Atkinson,  M.D. 

Attending  Surgeon. 
Frank  Martin,  B.Sc,  M.D. 

.4  tlending  Laryngologists. 
.John  R.  Winslow,  A.B.,  M.D.  Richard  H.  Johnston,  M.D. 

Attending  Dermatologist. 
John  R.  Abercrombie,  A.B.,  M.D. 

Attending  Pathologist. 
Howard  J.  Maldeis,  M.D. 

Attending  Urologist. 
Gideon  Timberlake,  M.D. 


BAYVIEW    HOSPITAL    STAFF  19- 

Attending  Oculist  and  Aurist. 
William  Tarun,  M.D. 

Attending  Neurologist. 
Irving  J.  Spear,  M.D. 

Attending  Dentist. 
G.  E.  P.  Truitt,  D.D.S. 

Consulting  Surgeons. 

L.  McLane  Tiffany,  A.B.,  M.D.    W.  S.  Halsted,  A.B.,  LL.D.,  B.Sc,  M.D. 

Randolph  Winslow,  A.M.,  M.D.,  LL.D.,  J.  M.  T.  Finney,  A.B.,  M.D. 

Archibald  C.  Harrison,  M.D. 

Consulting  Physicians. 

Thomas  R.  Brown,  A.B.,  M.D.  Llewellys  F.  Barker,  A.B.,  M.D. 

Thomas  B.  Futcher,  A.B.,  M.D.  Charles  W.  Mitchell,  A.M.,  M.D. 

William  S.  Thayer,  A.B.,  M.D. 

Consulting  Oculist. 
Hiram  Woods,  A.B.,  M.D. 

Consulting  Laryngologist. 
John  N.  MacKenzie,  A.B.,  M.D. 


STAFF   OF   THE   CITY   HOSPITAL   AT   BAYVIEW. 

Thomas  R.  Boggs,  S.B.,  M.D.,  Physician-in-Chief. 

Arthur  M.  Shipley,  M.D.,  Surgeon-in-Chief. 

Gordon  Wilson,   M.D.,    Physician-in-Chief  to   the   Municipal   Hospital  for 

Tuberculosis. 

Milton  C.  Winternitz,  A.B.,  M.D.,  Pathologist. 

R.  G.  HussEY,  A.B.,  M.D.,  Assistant  Pathologist. 


CONSULTING   STAFF. 

Ophthalmologist. 
James  J.  Mills,  M.D. 


20  NURSERY    AND    CHILd's    HOSPITAL    STAFF 

Laryngologisl. 
Frank  Dyer  Sanger,  M.D. 

Otologist. 
William  Tarun,  M.D. 

Neurologist. 
Henry  M.  Thomas,  M.D. 


ST.   ELIZABETH   HOME. 

Attending  Physician. 
Edgar  B.  Friedenwald,  M.D. 

Surgeon. 
Alexius  McGlannan,  M.D. 

Neurologist. 
A.  C.  GiLLis,  M.D. 


STAFF   OF  NURSERY  AND  CHILD'S  HOSPITAL. 

Attending  Physicians. 

Chas.  F.  Bevan,  M.D.  Edgar  B.  Friedenwald,  M.D. 

John  Ruhrah,  M.D. 

Resident  Physician. 
P'rances  Hertzog,  M.D. 

Consulting  Physicians. 

John  W.  Chambers,  M.D.  \Vm.  S.  Baer,  M.D. 

Wm.  F.  LocKwoop,  M.D.  Albertus  Cotton,  M.D. 

Oculist  and  Aurist. 

Harry  Friedenwald,  M.D. 

SupeiKntendent . 
Miss  Elizabeth  M.  Stone;, 


MARYLAND    LYING-IN   HOSPITAL    STAFF  21 

ST.   VINCENT'S   INFANT   ASYLUM. 

Visiting  Physicians. 

Charles  O'Donovan  A.iM.,  M.D.  Eugene  H.  Hayward,  M.D. 

J.  E.  PouLTON,  M.D.  J.  K.  B.  E.  Seegar,  M.D. 

J.  F.  Powers,  M.D.  Charles  B.  Wheltle,  M.D. 

Visiting  Surgeons. 

Frank  Martin,  B.S.,  M.D.  John  D.  Blake,  M.D. 

R.  B.  Warfield,  M.D.  Alexius  McGlannan,  M.D. 

Visiting  Oculists  and  Aurists. 
J.  Frank  Crouch,  M.D.  Clyde  E.  Clapp,  M.D. 

Visiting  Orthopedic  Surgeons. 
Sydney  M.  Cone,  A.M.,  M.D.  Compton  Riely,  M.D. 

Visiting  Proctologist. 
G.  Milton  Linthicum,  A.M.,  M.D. 

Pathologists. 
Sydney  M.  Cone,  A.M.,  M.D.  .\lexius  McGlannan,  M.D. 

Resident  Interne. 
Cornelius  L.  Donahue. 


MARYLAND  LYING-IN  HOSPITAL  (MATERNITE) 

Visiting  Obstetricians. 

George  W.  Dobbin,  M.D.  Glenn  M.  Litsinger,  M.D. 

Charles  E.  Brack,  M.D. 

Resident  Obstetrician. 
LuciEN  A.  Chaput,  M.D. 


MARYLAND   LYING-IN   HOSPITAL. 

Obstetrician'i. 
J.  M.  H.  Rowland,  M.D.  L.  E.  Nealb,  M.D. 

Associates. 

J.  K.  B.  E.  Seegar,  M.D.  H.  S.  Gorsuch,  M.D. 

H.  N.  Freeman,  M.D. 

Resident  Obstetrician. 
Geo.  R.  Patrick,  M.D. 


22  UNIVERSITY    HOSPITAL    DISPENSARY    STAFF 

UNIVERSITY    HOSPITAL   DISPENSARY    STAFF. 
John  Houff,  M.D.,  Dispensary  Physician. 

Frank  S.  Lynn,  M.D.,  Chief  of  Out-Patient  Department. 

H.  D.  McCarty,  M.D.,  Wilbur  P.  Stubbs,  M.D.,  G.  M.  Settle,  A.B.,  M.D., 
Chiefs  of  Clinic  to  the  Professor  of  Medicine. 

S.  R.  Clarke,  M.D.,  R.  C.  Metzel,  M.D.,  H.  U.  Todd,  M.D.,  VV.  G.  Clop- 
ton,  M.D.,  Eugene  Kerr,  M.D.,  M.  S.  Schimmel,  M.D.,  Le  Compte 
Cook,  M.D.,  Assistants. 

R.  P.  Bay,  M.D.,  Chief  of  Clinic  to  the  Professor  of  Surgery. 
Frank  S.  Lynn,  M.D.,  Associate  Chief  of  Clinic. 

Fred.  Rankin,  A.M.,  M.D.,  Thos.  L.  Phillips,  M.D.,  Edgar  S.  Perkins, 
M.D.,  Charles  R.  Edwards,  M.D.,  H.  M.  Foster,  M.D.,  Assistants. 

Jose  L.  Hirsh,  A.B.,  M.D.,  Professor  of  Clinical  Pediatrics. 
G.  Carroll  Lockard,  M.D.,  Chief  of  Clinic. 

J.  A.  Skladowsky,  M.D.,  C.  W.  Rauschinbach,  M.D.,  Robert  C.  Nitsch, 
A.B.,  M.D.,  Assistants. 

VV.  K.  White,  M.D.,  R.  L.  Mitchell,  M.D.,  R.  G.  Willse,  M.D.,  L.  H. 
Douglas,  M.D.,  Chiefs  of  Clinic  to  the  Professor  of  Diseases  of  Women. 

Wm.  Tarun,  M.D.,  Chief  of  Clinic  to  the  Professor  of  Eye  and  Ear  Diseases. 
E.  a.  Looper,  M.D.,  Assistant. 

John  R.  Abercrombie,  A.B.,  M.D.,  L.  W.  Ketron,  A.B.,  M.D.,  Chiefs  of 

Clinic  to  the  Professor  of  Dermatology. 
H.  M.  Robinson,  M.D.,  Assistant. 

A.  H.  Carroll,  M.D.,  Chief  of  Clinic  to  the  Professor  of  Diseases  of  the  Stomach. 
J.  Harry  Ulrich,  M.D.,  Assistant. 

H.  C.  Davis,  M.D.,  Chief  of  Clinic  to  the  Professor  of  Diseases  of  the  Throat 

and  Nose. 
H.  L.  SiNSKEY,  M.D.,  Assistant. 

R.  Tunstall  Taylor,  A.B.,  M.D.,  Professor  of  Orthopedic  Surgery. 

CoMPTON  RiELY,  M.D.,  Chief  of  Clinic. 

W.  Harry  Daniels,  M.D.,  Louis  A.  Buie,  A.B.,  M.D.,  Assistants. 

Gideon  Timberlake,  M.D.,  Professor  of  Genito-Urinary  Diseases. 
A.  J.  Underbill,  M.D.,  Chi''f  of  Clinic. 

Irving  J.  Spear,  M.D.,  Professor  of  Neurology. 

George  M.  Settle,  M.D.,  Chief  of  Clinic. 

A.  L.  Fehsenfeld,  M.D.,  Benjamin  Puskhin,  M.D.,  Assistants. 

G.  Milton  Linthicum,  M.D.,  Professor  of  Diseases  of  Rectum  and  Colon. 
J.  D.  Reeder,  M.D.,  Chief  of  Clinic  of  Diseases  of  Rectum  and  Colon. 

John  E.  O'Neill,  M.D.,  Chief  of  Pulmonary  Tuberculosis  Clinic. 

H.  N.  Freeman,  M.D.,  L.  H.  Douglas,  M.D.,  Chiefs  of  Clinic  to  the  Pro- 
fessor of  Obstetrics. 


MERCY    HOSPITAL    DISPENSARY    STAFF  23 

DISPENSARY   STAFF   OF   MERCY   HOSPITAL. 

Physician  in  Charge. 
B.  S.  Hanna,  M.D. 

Surgery. 
E.  H.  HuTCHiNs,  M.D.  Thos.  R.  Chambers,  M.D. 

A.  M.  Evans,  M.D.  F.  L.  Jennings,  M.D. 

Genito-Urinary  Surgery. 

Anton  G.  Rytina,  M.D. 
Wm.  J.  Todd,  M.D.  A.  E.  Goldstein,  M.D. 

A.  L.  TuMBLESON,  M.D.  Harris  Goldman,  M.D. 

Orthopedic  Surgery. 
Albertus  Cotton,  M.D. 

Medicine. 
Harvey  G.  Beck,  M.D.  W.  G.  Coppage,  M.D. 

B.  S.  Hanna,  M.D.  A.  A.  Sienkiewicz,  M.D. 

Diseases  of  Stomach. 

Julius  Friedenwald,  M.D.  John  G.  Stiepel,  M.D. 

T.  Fred'k  Leitz,  M.D.  Theodore  Morrison,  M.D. 

Nervous  Diseases. 

A.  C.  GiLLis,  M.D. 
G.  F.  Sargent,  M.D.  D.  D.  V.  Stuart,  Jr.,  M.D. 

Otto  H.  Duker,  M.D.  W.  A.  Boyd,  M.D. 

Diseases  of  Children. 

C.  L.  Joslin,  M.D. 

F.  N.  HiLLis,  M.D.  Frank  Ayd,  M.D. 

Diseases  of  Women. 
A.  Samuels,  M.D.  J.  G.  Onnen,  M.D. 

Emil  Novak,  M.D.  .        C.  F.  J.  Coughlin,  M.D. 

Diseases  of  Nose  and  Throat. 

Frank  Dyer  Sanger,  M.D. 

G.  W.  Mitchell,  M.D.  John  Wade,  M.D. 
W.  C.  Stifler,  M.D.  W.  F.  Zinn,  M.D. 

Diseases  of  Eye  and  Ear. 

Harry  Friedenwald,  M.D. 
H.  K.  Fleckenstein,  M.D.  Jos.  I.  Kbmlbr,  M.D. 


24  MARYLAND    GENERA.L    HOSPITAL    DISPENSARY    STAFF 

N euro-Otology. 
J.  W.  Downey,  Jr.,  M.D. 

Diseases  of  the  Rectum. 
C.  F.  Blake,  M.D.  Louis  J.  Rosenthal,  M.D. 

Diseases  of  Skin. 
Melvin  Rosenthal,  M.D.  B.  V.  Kelly,  M.D. 


MARYLAND    GENERAL   HOSPITAL   DISPENSARY   STAFF, 

Committee  in  Charge. 

Clyde  A.  Clapp,  M.D.,  Chairman. 
Maurice  Lazenby,  M.D.,  Arthur  G.  Barrett,  M.D. 

Medicine. 

Charles  O'Donovan,  A.M.,  M.D.  L.  M.  C.  Parker,  M.D. 

J.  Wesley  Cole,  M.D.  Frank  J.  Powers,  M.D. 

O.  V.  LiNHARDT,  M.D.  Charles  B.  Wheltle,  M.D. 

J.  W.  V.  Clift,  M.D. 

Surgery. 
Arthue  G.  Barrett,  M.D.  J.  B.  Culverhouse,  M.D. 

Herbert  Blake,  M.D.  J.  D.  Bubert,  M.D. 

No-^e  and  Throat. 
George  Murgatroyd,  M.D.  Wm.  Caspari,  M.D. 

Eye  and  Ear. 
Clyde  A.  Clapp,  M.D.  Reginald  D.  West,  M.D. 

Rectal  Diseases. 

Ernest  Marr,  M.D. 

Urology. 
J.  B.  Culvbrhouse,  M.D.  R.  B.  Kbnyon,  M.D. 

Diseases  of  the  Stomach. 
F.  E.  Shipley,  M.D. 

Children. 
L.  M.  C.  Parker,  M.D.  Chas.  B.  Wheltle,  M.D. 

O.   V.  LiNHARDT,   M.D. 


MARYLAND    GENERAL    HOSPITAL    DISPENSARY    STAFF 
Gynecology. 


25 


Maurice  Lazenby,  M.D. 
Sydney  Streett,  A.B.,  M.D. 


J.  M.  H.  Rowland,  M.D. 
J.  K.  B.  E.  Seegar,  M.D. 


Irving  J.  Spear,  M.D. 
Benjamin  Pushkin,  M.D. 


Obstetrics. 


Neurology. 


J.  M.  Fenton,  M.D. 
Eugene  Hayward,  M.D. 


H.  S.  GoRsucH,  M.D. 
H.  N.  Freeman,  M.D. 


A.  C.  GiLLis,  A.M.,  M.D. 
D.  D.  V.  Stuart,  Jr.,  M.D. 


Wm.  a.  Boyd,  B.S.,  M.D. 

Dermatology. 
E.  R.  Strobel,  M.D. 

Diseases  of  Chest. 
J.  W.  Cole,  M.D. 


MATRICULATES,  UNIVERSITY  OF  MARYLAND, 

SCHOOL  OF  MEDICINE  AND  COLLEGE  OF 

PHYSICIANS  AND  SURGEONS, 

1915—1916. 


POST-GRADUATES   AND    SPECIAL   STUDENTS. 


Name.  State. 

BoBBiTT,  Ray  Maxwell,  M.'D...West  Virginia 

Bowes,  William  Joseph,  A.B Maryland 

Crockett,  John  Henry Virginia 

D'Angelo,  B.  F.,  M.D New  York 

Dembrow,  William  L Virginia 

Hale,  Nathan  G.,  M.D loiva 

Harsh,  E.  Herbert,  M.D Ohio 

Jackvony,  Albert  H.,  Phar.  D..  .Rhode  Island 

Jones,  W.  W.,  M.D Iowa 

Koch,  Arthur  E.,  A.B.,  M.D Ohio 

Laham,  Jamil  Tannus Palestine 

Lopez,  Teodoro,  M.D Mexico 

Lyles,  William  Boykin,  M.T)... South  Carolina 
McElwee,  Ross  S.,  M.D North  Carolina 


Name.  State. 

McGuire,  George  Thomas,  M..T) .Pennsylvania 

Maresca,  Robert  J New  Jersey 

Masley,  Michael  George Pennsylvania 

Michelson,  Lewis,  M.D California 

Morgan,  Edward  A.,  M.D West  Virginia 

Naikblis,  Stanley,  B.S Connecticut 

Nelson,  Matthew  Anton,  B.S Utah 

Parlade,  Jaime  Anjel,  Phar.D Cuba 

Player,  Lionel  Paget,  M.D California 

Speas,  W.  p.,  M.D Ncyrth  Carolina 

Watts,  Charles  N.,  M.D West  Virginia 

Willoughby,  M.  Kemper,  M.D New  York 

Zeller,  Eugene  J.  K.,  M.D Maryland 


FOURTH  YEAR  CLASS. 


Aikman,  David  McAllister Pennsylvania 

Anderson,  Franklin  B Maryland 

Arnest,  Richard  Turberville Virginia 

Baggott,  Bartus  Trew Maryland 

Bailin,  Robert New  York 

Baldwin,  Anton,  Jr Maryland 

Bawden,  George  Abner Maryland 

Beck,  Foster  A Pennsylvania 

Bennett,  Percival  Robert North  Carolina 

Benson,  Edward  H Maryland 

BiCKLEY,  William  Ernest,  A.B.  South  Carolina 

Biddle,  Benjamin  Harrison Ohio 

Bishop,  Everett  Lassiter Georgia 

Bolen,  Henry  L Massachusetts 

Brat,  Thomas  Lath.^m North  Carolina 

Brooke,  Charles  R Maryland 

Brown,  Thomas  E.,  Jr Pennsylvania 

Brumbaugh,  Benjamin  Bruce,  Phar.D. 

Maryland 

Buettner,  Henry  Fred  John Maryland 

Burton,  Charles  H ammon Maryland 

Byington,  S.  Bury District  of  Columbia 

Byrne,  Ign.vtius  P.  A New  York 

Cannon,  James  M West  Virginia 

Carter,  Paul  Conway,  B.S...  .North  Carolina 

Carrasquillo,  Honorio  F Porto  Rico 

Cavallo,  Michael  Edward Neir  York 


Chandler,  James  J.,  A.B South  Carolina 

Chaput,  Lucibn  R Massachusetts 

Childs,  C.  Chapin New  York 

Cole,  Lewis  Furbeck New  York 

CoLTRANE,  John  W North  Carolina 

CoMPTON,  A.  Fillmore West  Virginia 

Crook,  Charles  S Maryland 

Cudd,  James  Erric,  A.B South  Carolina 

Day,  Sa.muel  Thomas,  Jr New  Jersey 

Dillon,  William  Joseph Massachusetts 

DoMiNGUEZ,  To.viAS Porto  Rico 

Dunne,  Edward  P Connecticut 

Eby,  John  Cyril,  Phar.  D Marylana 

Evans,  John  E.,  A.B South  Carolina 

Eyestone,  Fred  L Ohio 

Feinglos,  Israel  J Maryland 

Feldm.\n,  Maurice Maryland 

Fbrneyhough,  Willie  Todd Virginia 

Ferry,  Bernard  Joseph Pennsylvania 

Finklbstein,  Max New  York 

Flynn,  William  H Connecticut 

Foard,  Fred  T.,  Jr North  Carolina 

Foley,  Joseph  D Connecticut 

Foley,  Matthew  J Maryland 

Folk,  Robert  Hamilton,  A.B.  .South  Carolina 

Fox  WELL,  Raymond  K Maryland 

Gaonon,  Arthur  J Rhode  Island 


26 


MATRICULATES    1915-1916 


27 


Name.  State. 

Gannon,  Clarence  Lee New  York 

Gatsopoulos,  Peter  N Massachusetts 

GiLLETT,  Harold  E New  York 

GiNSBURG,  Jacob  B Maryland 

Glatzau,  Lewis  W Florida 

Goldman,  Harry Maryland 

Gonzales,   Jose   Felipe   Gonzales  y 

Porto  Rico 

Growt,  Bowers  H Maryland 

Gruetzner,  Edward  T Pennsylvania 

Gwynn,  George  Humphrey,  Jr Florida 

Gwynn,  Humphrey  Wilson Florida 

Hahn,  Albert  Gaither North  Carolina 

Hammer,  Howell  Inskip,  Ph.G Maryland 

Hanigan,  S.  Roscoe Pennsylvania 

Hege,  J.  Roy North  Carolina 

Hennessy,  Jay  Tyrrell New  York 

Howard,  Lewis  H Maryland 

Hundley,  Frank  S Maryland 

HuTTON,  Daniel  Cogdell North  Carolina 

Jacobson,  Benard  S Maryland 

Jaffe,  Benjamin  Meyer Maryland 

Knapp,  Lee  Henry New  Hampshire 

Kritzer,  Henry  Rowland Virginia 

Ktle,  Paul  M.^xwell West  Virginia 

Law,  Harry  D Maryland 

Lay,  Juan  A Cuba 

Lazenb Y,  Allen  D Maryland 

Light,  Ellsworth  Emmett Massachusetts 

Long,  Clark  Samuel Pennsylvania 

Lopez,  Eufemio  N.  Bocanegra,  Phar.  D. 

Pcrrto  Rico 

Lovely,  Bernard  Henry New  Hampshire 

LowsLEY,  Augustus  S, California 

Lupton,  Charles  H North  Carolina 

McCamey,  Kenneth  E Pennsylvania 

McKenna,  William  H Rhode  Island 

McLean,  George Maryland 

Machin,  Frank  H Maryland 

Madden,  William  L New  Jersey 

Marino,  Frank  C Maryland 

Martin,  Frank  S Maryland 

Matthai,  Jacob  Henry Ulinois 

Mason,  Frank  E Maryland 

Maxwell,  John  A.,  A.B Connecticut 

Mayo,  Woodward  B Utah 

Mejias,  Francisco  J Porto  Rico 

Mellor,  Royal  B Maryland 

Merkel,  Henry  Anton Maryland 

Miller,  John  E Vermont 

Miller,  Lawrence  G Maryland 

Mitchell,  Henry  S Maryland 


Name.  State. 

Morales,  Ricardo  Ramirez  y Porto  Rico 

Nevling,  Ai  Boynton Pennsylvania 

Nicholson,  Frank  P New  York 

NiCKLAS,  John  M Maryland 

NoELL,  Robert  Holman North  Carolina 

O'Brien,  Joseph  Gerald Maryland 

O'Brien,  Thomas  Francis Connecticut 

Oddo,  Vincent New  York 

Oduber,  Jacob Dutch  West  Indies 

O'Malle Y,  William  F New  York 

O'Neill,  Gonzalo,  Jr New  York 

Pasuth,  Bartholomew  Charles.   Connecticut 

Patrick,  George  R North  Carolina 

Payawal,  Juan  L.,  A.B Philippine  Islands 

Penabaz,  Fernando,  B.S Cuba 

Peterson,  Arthur  F Massachusetts 

Pole,  Charles  A Maryland 

Porter,  Lyman  R Maryland 

Post,  Guy  Re yman West  Virginia 

Pruitt,  Samuel  O.,  A.B South  Carolina 

Reier,  Adam  William Maryland 

Reifschneider,  Charles  Adam Maryland 

Rice,  George  William Maryland 

Rigby,  Cecil,  B.S South  Carolina 

Rios,  Manuel  G.  de  Quevedo Porto  Rico 

Roberts,  Joseph  John Connecticut 

Rogers,  Herbert  W Virginia 

RoLENSON,  Julio  R Porto  Rico 

RuziCKA,  F.  Frederick,  A.B.,  AM...  Mary  land 

Santos-Buch,  Angel  M.,  Lit.B Cuba 

Savannah,  Joseph  G New  Jersey 

Shetter,  Andrew  G Pennsylvania 

Shirkey,  Wilbur  Fiske,  Jr West  Virginia 

Short,  Noah  Haqeman West  Virginia 

Sloan,  William  Henry,  B.S..  ..North  Carolina 

Snyder,  Samuel Maryland 

Stein,  Harold  Milton New  Jersey 

Sternberg,  Abraham  Tobias Palestine 

Strandberg,  Herbert  Lawrence. iVeu;  Jersey 

Suzuki,   Yoshio,   M.D > Japan 

Syrop,  Edward  Franklin New  York 

Tay,  Justin  Carlton Massachusetts 

Thomas,  Edward  P Maryland 

Thompson,  Edwin  Brice Ohio 

Tickle,  Thomas  Gooch West  Virginia 

Van  Poole,  Carl  M North  Carolina 

Voss,  Norwood  W.,  A.B Maryland 

Wellman,  Harrison  M Pennsylvania 

Wentz,  Maurice  Cornelius,  B.S Maryland 

Whittle,  William  Oscar Virginia 

Williams,  W.  Frederick Maryland 

Wolfe,  Humphrey  D Maryland 

155 


THIRD  YEAR  CLASS. 


Armstrong,  Fred  Francis Connecticut 

AuDET,  Charles  Henry Massachusetts 

Bampfield,  Fred  J Canada 


Barishaw,  Samuel New  Jersey 

Bennet,  Da  Costa,  A.B Maine 

Bloom,  George  Homer Maryland 


28 


MATRICULATES    1915-1916 


Xame.  Slate. 

Bloom,  Lawrence  H New  Jersey 

BoHL,  Lnis  Joseph New  Jersey 

Bonner,  Octavius  B North  Carolina 

Brounshas,  Ipolitas  B New  York 

Burrows,  Ernest  A Massachusetts 

Brynes,  Thomas  E Massachusetts 

Carlin,  Edward  J.  M New  Jersey 

Carroll,  H.  Roland Maryland 

Champlin,  Roy  D New  York 

Clark,  Frederick  H Georgia 

CouLON,  Frank  N New  Hampshire 

Covey,  William  Crockett West  Virginia 

Crawford-Frost,  John  I Maryland 

Darby,  W.  Arthur Maryland 

Daves,  John  Thomas Virginia 

Davidson,  William  B Rhode  Island 

Diebolder,  Oscar Germany 

Donahue,  Cornelius  L New  York 

Doyle,  Joseph  F Massachusetts 

Duffy,  Vincent  P West  Virginia 

Ehlers,  Reginald  G.  M.,  'M.'D.V  ...  .California 

Eleder,  Franklin  C Maryland 

Eisenberg,  Albert Maryland 

Ephraim,  Meyer Maryland 

Fay,  Daniel  E Maryland 

Fernandez,  Luis  J Porto  Rico 

Frost,  Nugent  G New  York 

Gallagher,  William  E Neiv  York 

Giesen,  John  Jacob,  A.B Virginia 

Hartman,  George  Otto Ohio 

Hertzog,  Francis  C Pennsylvania 

Hedrick,  Erland  H West  Virginia 

Hodges,  Henry  Stuart North  Carolina 

Holmes,  James Massachusetts 

Howell,  James  E.,  B.S North  Carolina 

Huff,  Wheeler  O Maryland 

Johnson,  Harley  M South  Carolina 

Kaufman,  Edgar  W Pennsylvania 

Ketcherside,  Hillary  D Arizona 

Kirk,  William  V West  Virginia 

Krause,  Louis  A'.  M Maryland 

KopRivicH,  Milan  I.  S Serbia 

Labares,  Gregory  A.,  A.B.  Philippine  Islands 

Lasher,  Lemuel  A Pennsylvania 

Legge,  Kenneth  D District  of  Columbia 

McClintock,  George  L Pennsylvania 

MacGregor,  Allan  W Connecticut 

Maddison,  W.  E Utah 

Marston,  James  Graham,  A.B Maryland 

Martin,  John  Willis Maryland 


Name.  State. 

Martinez,  Jose Porto  Rico 

Melroy,  Raymond  S Pennsylvania 

Merrick,  Frank  X New  York 

Michael,  Marion  Harl.^n Maryland 

Miller,  Wilfred  Porter,  M.E New  York 

Montgomery,  Mathison  J Pennsylvania 

MoRAN,  Arthur  B Connecticut 

Moyers,  Emmet  D West  Virginia 

MuLCAHY,  Francis  J Massachusetts 

Nagourney',  Leon New  York 

NoHE,  C.  C West  Virginia 

Nolan,  Francis  F Virginia 

NoRRis,  J.  Edward Maryland 

Ogden,  Frank  N Maryland 

O'Neill,  Joseph  T .Massachusetts 

Peeler,  Casper  S.,  B.S Florida 

Peery,  Clarence  E Virginia 

PoRTERFiBLD,  M ARVIN  H West  Virginia 

Reddig,  Clarence  M.,  Ph.  B Pennsylvania 

Reitzel,  Elbert  Coy North  Carolina 

Reynolds,  Paul  Emerson Maryland 

Rigau,  Gabriel Porto  Rico 

Rigby,  Samuel  B Utah 

Rodriguez,  Antonio,  Jr Porto  Rico 

Salan,  Joseph Indiana 

Shaver,  William  T North  Carolina 

Shayt,  Louis Maryland 

Silverstein,  Max New  York 

Skilling,  John  G Maryland 

Smith,  Leo  L Oklahom,a 

Smith,  Leroy  H Maine 

SoRiN,  Israel  C New  Jersey 

Stein,  Albert Massachusetts 

Tarkington,  Grayson  E Arkansas 

Thomas,  Kelly  C North  Carolina 

Tierney,  Edward  F Rhode  Island 

Vaughan,  George  W Maryland 

Vicwig,  Max  W West  Virginia 

Weber,  John  J Maryland 

Welch,  Robert  S.  G Maryland 

Whe ATON,  Harry  W New  York 

Wheeler,  Howard  Lawrence Maryland 

Whistler,  Edward  L.,  A.B Pennsylvania 

White,  George  L Maryland 

Williams,  William  C North  Carolina 

Wolff,  Carl  O.,  A.B North  Carolina 

WoLFORD,  Roy  A West  Virginia 

Worrell,  Churchill  F Virginia 

Yost,  Fielding  Ernest  Lee West  Virginia 

105 


SECOND  YEAR  CLASS. 


Allen,  Eustace  A.,  A.B Alabama 

Anderson,  Lang  W South  Carolina 

Andrew,  Clarence  Pridmore,  A.B. 

South  Africa 

Bird,  LaRue Pennsylvania 

Block,  David  S Maryland 


Briscoe,  Ever.^rd Maryland 

Bross,  SamueYj  Isadore Maryland 

Cafritz,  Edward  Alexandria 

District  of  Columbia 

Chesbro,  Charles  C New  York 

Clark,  Harold  C New  Yurk 


MATRICULATES    1915-1916 


29 


Name.  Stale. 

CoHN,  Alexander Maryland 

D ALTON,  William  B North  Carolina 

DeFeo,  Charles  C Connecticut 

Deliz,  Ramon Pprto  Rico 

Dillon,  William  M New  York 

Fazenbaker,  Anderson  J Maryland 

Flippin,  Eugene  LiTTLEjOHN...A''oriA  Carolina 

G AVRONSKY,  Samuel New  Jersey 

Gleason,  John  Lewis Connecticut 

Griffith,  Wesley  Powell,  A.B.  Pennsulvania 
Hart,  Crawford  Avery,  A.B.  North  Carolina 

HouDE,  Arthur  J Massachusetts 

Hunter,  DeWitt  Talmage...  .  .North  Carolina 

Isaacs,  Raphael  Harris Maryland 

JoYNER,  James  C North  Carolina 

Kellam,  John  Wise Virginia 

Knowles,  J.  R Maryland 

La  Rue,  Raymond Ohio 

Leiva,  Carlos  Rivas Cuba 

Lynch,  Raymond  A West  Virginia 

Mackb,  Clarence  Edgar , . .  .Maryland 

McDade,  Brodie  B.\nks North  Carolina 

McLeod,  Walter  Guy North  Carolina 


Name.  State. 

Miller,  Daniel Maryland 

Morgan,  Zachariah  Raphael Maryland 

Penab.az,  Jose  A.,  A.B Cuba 

PiLSON,  Robert  Adrian Maryland 

Putterman,  Morris  Nathan Maryland 

RiDGELY,  Irwin  Oliver,  A.B Maryland 

Robles,  Charles  Walter Florida 

Russell,  Frank  J Maryland 

Sabiston,  Frank North  Carolina 

Seal,  Gratta  Earle West  Virginia 

Sindler,  Joseph Maryland 

Spbake,  Thomas  Carlyle,  A.B Maryland 

Sweet,  Alfred  Norton Connecticut 

Tannenbaum,  Frank New  York 

Taytlor,  Joseph  R Pennsylvania 

Thaureaux,  Eladio Cuba 

Thompson,  T.  F New  Jersey 

Thoner,  John  George West  Virginia 

Trippett,  L.  H.,  A.B West  Virginia 

TuLL,  Myron  G.,  A.B Maryland 

White,  S.  Howard,  A.B South  Carolina 

Woltz,  Charles  R Virginia 

55 


FIRST  YEAR  CLASS. 


Abbott,  Lyman  Sinclair Missouri 

Adams,  Edgar  P Maryland 

Alagia,  Damian  P Maryland 

Alexis,  Joseph Pennsylvania 

Barker,  Frank  Talmage Florida 

Beachley,  Ralph  Gregory Maryland 

Boone,  Walter,  Jr South  Carolina 

Brown,  James,  Jr North  Carolina 

BucHNESS,  John  Adam Maryland 

Campbell,  Arthur  Thomas Connecticut 

Clauss,  Leo  Carl Connecticut 

Crouch,  Norman Maryland 

Davis,  Charles  W.,  A.B North  Carolina 

Davis,  John  Edwar  j Virginia 

Demely,  Louis  Alvin Maryland 

Fl.^.herty,  John  Joseph Connecticut 

FoosE,  Wilbur  C,  Phar.D Pennsylvania 

Fort,  Wetherbee Maryland 

Franceschi,  Francisco Porto  Rico 

Ge  ,  er,  William  Glenville Maryland 

Gleason,  Joseph  H Massachusetts 

Goldsborough,  Charles  Reubull,  A.B. 

Maryland 
Hartenstein,  Albert  G.,  Pn.C.West  Virginia 
Helsabeck,  Chester  Joseph..  .North  Carolina 

HoRiNE,  Cyrus  Flook Maryland 

Ingram,  W.  Hawkins Maryland 

Jacobowitz,  Aaron Pennsylvania 


John,  Baxter  Schooley Virginia 

Kane,  Leo  Vincent,  A.B New  Jersey 

Kbnure,  James  Thom.\s,  B.S Connecticut 

Lonergan,  Paul  B .Pennsylvania 

Lumpkin,  Morgan  Le  Roy,  Pn.'R...  .Maryland 

McElwain,  Howard  Byer Pennsylvania 

Macis,  Salvador  A.,  A.B.,  B.S. 

Nicaragua,  C.  A. 

Mayoral,  Jo.^quin Cuba 

Morales,  Pablo,  Jr Porto  Rico 

MoRiSEY,  Raymond  F North  Carolina 

Murphy,  Benjamin  Russell New  Jersey 

Quintero,  Ernesto Porto  Rico 

Reynolds,  Roy  Rex. Virginia 

Richardson,  Ray  Walters Maryland 

RoMiNE,  Carl  Chester West  Virginia 

Shaw,  Wilfred  McLaurin,  A.B. 

South  Carolina 

Sheppard,  Henry,  Jr North  Carolina 

Sneiderman,  Benjamin  Robbht..  Connecticut 

Stewart,  Charles  Wilbur Maryland 

Tie.meyer,  Arthur  Charles Maryland 

Ti-mko,  Louis  Michael Pennsylvania 

Vazquez,  Rafael Porto  Rico 

White,  Thomas  Francis Delaware 

Whitted,  W.<.lter  Pdryear North  Carolina 

Wild,  Albert Connecticut 

Wright,  Harold  Edson New  York 

53 


30  SUMMARY    OF   STUDENTS 

GENERAL  SUMMARY  OF  STUDENTS  ATTENDING  THE  UNIVERSITY 
OF  MARYLAND,  SESSION  OF  1915-16. 

Department  of  Arts  and  Sciences  (St.  John's  College) 161 

School  of  Medicine 395 

Department  of  Law 425 

Dental  Department 147 

Department  of  Pharma-y 103 

Training  Schools  for  Nurses 238 

Total 1469 


GRADUATES  UNIVERSITY  OF  MARYLAND, 

SCHOOL  OF  MEDICINE  AND  COLLEGE 

OF  PHYSICIANS  AND  SURGEONS, 

JUNE    1,  1916. 


Name.  State. 

AiKMAN,  David  McAllister Pennsylvania 

Anderson,  Franklin  B Maryland 

Arnest,  Richard  Turberville Virginia 

Baggott,  Bartus  Trew Maryland 

Bawden,  George  Abner Maryland 

Beck,  Foster  A Pennsylvania 

Bennett,  Percival  Robert..  .   A^ort/i  Carolina 

Benson,  Edward  H Maryland 

BicKLET,  William  Ernest,  A.B. 

South  Carolina 

Biddle,  Benj.wmin  Harrison Ohio 

Bishop,  Everett  Lassiter Georgia 

Bray,  Thomas  Latham North  Carolina 

Brooke,  Charles  R Maryland 

Brown,  Thomas  E.,  Jr Pennsylvania 

Brumbaugh,  Benjamin  Bruce,  Phar.D. 

Maryland 

Buettner,  Henry  Fred  John Maryland 

Burton,  Charles  Hammon Maryland 

Bryne,  Ignatius  P.  A New  York 

Carter,  Paul  Conway,  ^.Q... North  Carolina 

Carrasquillo,  Honorio  F Porto  Rico 

Cavallo,  Michael  Edward New  York 

Chandler,  James  J.,  A.B South  Carolina 

Chaput,  Lucien  R Massachusetts 

Childs,  C.  Chapin Neil)  York 

Cole,  Lewis  Furbeck New  York 

CoLTRANE,  John  W North  Carolina 

CoMPTON,  A.  Fillmore West  Virginia 

CuDD,  James  Erric,  A.B South  Carolina 

Dillon,  William  Joseph Massachusetts 

Dominguez,  Tom  as Porto  Rico 

Dunne,  Edward  P Connecticut 

Evans,  John  E.,  A.B South  Carolina 

Eyestone,  Fred  L Ohio 

Feinglos,  Israel  J Maryland 

Feldman,  Maurice Maryland 

Ferne yhough,  Willie  Todd Virginia 

Ferry,  Bernard  Joseph Pennsylvania 

FiNKBLSTEiN,  Max Neiv  York 

Flynn,  William  H Connecticut 

Foard,  Fred  T.,  Jr North  Carolina 

Foley,  Joseph  D Connecticut 

Folk,  Robert  Hamilton,  A.B.,  South  Carolina 

FoxwELL,  Raymond  K Maryland 

Gannon,  Clarence  Lee Neiv  York 


Name.  State. 

Gatsopoulos,  Peter  N Massachusetts 

GiLLETT,  Harold  E New  York 

Glatzau,  Lewis  W Florida 

Goldman,  Harry Maryland 

Gonzales,  Jos6  Felipe  Gonzales  y 

Porto  Rico 

Growt,  Bowers  H Maryland 

Greutzner,  Edward  T Pennsylvania 

GwYNN,  George  Humphrey,  Jr Florida 

GwYNN,  Humphrey  Wilson Florida 

Hahn,  Albert  Gaither North  Carolina 

Hammer,  Howell  Inskip,  Ph.G Maryland 

Ha  nig  AN,  S.  Rdscoe Pennsylvania 

Hege,  J.  Roy North  Carolina 

Hennessy,  Jay  Tyrrell New  York 

Howard,  Lewis  H Maryland 

Hundley,  Frank  S Maryland 

HuTTON,  Daniel  Cogdell North  Carolina 

Jacobson,  Benard  S Maryland 

Jaffe,  Benjamin  Meyer Maryland 

Knapp,  Lee  Henry New  Hampshire 

Kyle,  Paul  Maxwell West  Virginia 

Lazenby,  Allen  D Maryland 

Light,  Ellsworth  Emmett Massachusetts 

Long,  Clark  Samuel Pennsylvania 

Lopez,  Eufemio  N.  Bocanegra,  Fhar.D. 

Porto  Rico 

Lovely,  Bernard  Henry New  Hampshire 

LuPTON,  Charles  H North  Carolina 

Madden,  William  L New  Jersey 

Marino,  Frank  C Maryland 

Matthai,  Jacob  Henry Illinois 

McCamey,  Kenneth  E Pennsylvania 

McLean,  George Maryland 

Mejias,  Francisco  J Porto  Rico 

Merkel,  Henry  Anton Maryland 

Miller,  John  E Vermont 

Miller,  Lawrence  G Maryland 

Morales,  Ricardo  Ramirez  y Porto  Rico 

Nevling,  Ai  Boynton Pennsylvania 

Nicholson,  Frank  P New  York 

Noell,  Robert  Holman North  Carolina 

O'Brien,  Joseph  Gerald Maryland 

O'Brien,  Thomas  Francis Connecticut 

Oddo,  Vincent New  York 

Oduber,  Jacob Dutch  West  Indies 


31 


32 


PRIZEMEN 


Name.  State. 

O'M ALLEY,  William  F New  York 

O'Neill,  Gonzalo,  Jr New  York 

Pabuth,  Bartholomew  Cn\nhES.  .Connecticut 

Patrick,  George  R North  Carolina 

Penabaz,  Fernando,  B.S Cuba 

Peterson,  Arthur  F Massachusetts 

Post,  Guy  Reyman West  Virginia 

Pruitt,  Samuel  O.,  A.B South  Carolina 

Reier,  Adam  William Maryland 

Reifschneider,  Charles  Adam Maryland 

Rice,  George  William Maryland 

RiGBY,  Cecil,  B.S South  Carolina 

Rios,  MAifuEi,  G.  DB  QuEVEDO Porto  Rico 

Roberts,  Joseph  John Cpnnecticut 

Rogers,  Herbert  W Virginia 

Rolenson,  Julio  R Porto  Rico 

RuzicKA,  F.  Frederick,  A.B.,  A.M.  .Maryland 
Santos-Buch,  Angel  M.,  Lit.B Cuba 


Name.  State. 

Shirkey,  Wilbur  Fiske,  Jr West  Virgitiia 

Short,  Noah  Hageman West  Virginia 

Sloan,  William  Henry,  B.S... iVoriA  Carolina 

Snyder,  S,\muel Maryland 

Stein,  Harold  Milton New  Jersey 

Sternberg,  Abraham  Tobias Palestine 

Strandberg,  Herbert  Lawrence 

New  Jersey 

Syrop,  Edward  Franklin New  York 

Thomas,  Edward  P Maryland 

Tickle,  Thomas  Gooch West  Virginia 

Van  Poole,  Carl  M North  Carolina 

Voss,  Norwood  W.,  A.B Maryland 

Wellman,  Harrison  M Pennsylvania 

Wentz,  Maurice  Cornelius,  B.S. . .  .Maryland 

Whittle,  William  Oscar Virginia 

Williams,  W.  Frederick Maryland 

Wolfe,  Humphrey  D Maryland 

123 


PRIZEMEN 
UNIVERSITY  GROUP 

University  Prize — Gold  Medal Frank  C.  Marino 

Cerlifcates  of  Honor. 

Benard  S.  Jacobson  Honorio  F.  Carrasquillo 

Harrison  M.  Wellman  Cecil  Rigby 

Robert  H.  Folk. 

COLLEGE  OF  PHYSICIANS  AND  SURGEONS  GROUP 


Medal  Men. 


Kenneth  E.  McCamey 
Humphrey  D.  Wolfe 


Lewis  H.  Howard 
Guy  R.  Post. 


Entitled  to  Honorable  Mention. 


D.  M.  Airman 
■     E.  P.  Dunne 


George  McLean 
A.  F.  Peterson. 


THE  UNIVERSITY  OF  MARYLAND 
SCHOOL  OF  MEDICINE 

AND  THE 

COLLEGE  OF  PHYSICIANS  AND 
SURGEONS. 

UNITED  IN    1915,  AND  HEREAFTER  THE  TWO  SCHOOLS 
WILL  BE  CONDUCTED  AS  ONE. 

As  a  result  of  the  merger  accomplished  in  1915  the  combined 
schools  offer  the  student  the  abundant  resources  of  both  institutions, 
and,  in  addition,  by  earlier  combination  with  the  Baltimore  Medi- 
cal College,  the  entire  equipment  of  three  large  medical  colleges. 

The  School  of  Medicine  of  the  University  of  Maryland  is  one  of 
the  oldest  foundations  for  medical  education  in  America,  ranking 
fifth  in  point  of  age  among  the  medical  colleges  of  the  United  States. 
It  was  chartered  in  1807,  under  the  name  of  the  College  of  Medicine 
of  Maryland,  and  its  first  class  was  graduated  in  1810.  In  1812 
the  College  was  empowered  by  the  Legislature  to  annex  three  other 
colleges  or  faculties,  of  Divinity,  of  Law  and  of  Arts  and  Sciences, 
and  the  four  colleges  thus  united  were  "constituted  an  Universuy 
by  the  name  and  under  the  title  of  the  University  of  Maryland." 

Established  thus  for  more  than  a  century,  the  School  of  M  di- 
cine  of  the  University  of  Maryland  has  always  been  a  leading  medi- 
cal college,  especially  prominent  in  the  South  and  widely  known 
and  highly  honored  throughout  the  country. 

The  beautiful  college  building  at  Lombard  and  Greene  Streets, 
erected  in  1814-1815,  is  the  oldest  structure  in  America  devoted 
to  medical  teaching.  Here  was  founded  one  of  the  first  medical 
libraries  and  the  first  medical  college  library  in  the  United  States. 

Here  for  the  first  time  in  America  dissecting  was  made  a  com- 
pulsory part  of  the  curriculum ;  here  instruction  in  Dentistry  was 
first  given  (1837),  and  here  were  first  installed  independent  chairs 
for  the  teaching  of  Diseases  of  Women  and  Children  (1867)  and  of 
Eye  and  Ear  Diseases  (1873). 

The  School  of  Medicine  was  one  of  the  first  to  provide  for 
adequate  clinical  instruction  by  the  erection  in  1823  of  its  own 

33 


34  CLINICAL    FACILITIES 

hospital,  and  in  this  hospital  intra  mural  residency  for  the  senior 
student,  now  available  for  the  whole  class,  was  first  established. 

In  1913  juncture  was  brought  about  with  the  Baltimore  Medi- 
cal College,  an  institution  of  32  years  growth.  By  this  association 
the  facilities  of  the  School  of  Medicine  were  enlarged  in  faculty, 
equipment  and  hospital  connection. 

The  College  of  Physicians  and  Surgeons  was  incorporated  under 
the  Legislative  enactment  in  1872  and  established  on  Hanover 
Street  in  a  building  afterwards  known  as  the  Maternity,  the  first 
obstetrical  hospital  in  Maryland.  In  1878  union  was  effected 
with  the  Washington  University  School  of  Medicine,  in  existence 
since  1827,  and  the  College  was  removed  to  its  present  location 
at  Calvert  and  Saratoga  Streets.  By  this  arrangement,  medical 
control  of  the  City  Hospital,  now  the  "Mercy  Hospital,  was  obtained, 
and  on  this  foundation  in  1899  the  present  admirable  college  build- 
ing was  erected. 


CLINICAL  FACILITIES. 

HOSPITALS  AND  DISPENSARIES. 
UNIVERSITY  HOSPITAL. 

The  University  Hospital,  which  is  the  property  of  the  Faculty  of 
Physic  of  the  University  of  Maryland,  is  the  oldest  institution  for 
the  care  of  the  sick  in  the  State  of  Maryland.  It  was  opened  in 
September,  1823,  under  the  name  of  the  Baltimore  Infirmary,  and 
at  that  time  consisted  of  but  four  wards,  one  of  which  was  reserved 
for  eye  cases.  By  successive  additions  this  hospital  was  increased 
to  more  than  fourfold  its  original  accommodations,  there  being  added 
to  it  a  large  clinical  amphitheater,  a  students'  building  for  the  accom- 
modation of  the  thirty  clinical  assistants,  and  a  nurses'  building 
for  the  accommodation  of  the  pupils  of  the  Training  School  for  Nurses. 
The  yearly  increase  in  the  number  of  patients  seeking  admission  to 
the  hospital,  however,  more  than  kept  pace  with  the  increase  in  ac- 
commodations, and  the  Faculty  therefore  erected  an  entirely  new  and 
modem  hospital  of  fully  double  the  capacity  of  the  former  building. 

The  University  Hospital  is  constructed  of  brick  and  Tennessee 
limestone  in  the  Colonial  style  of  architecture,  fronting  175  feet  upon 
Lombard  Street,  and  about  the  same  on  Greene  Street.  It  is  suppHed 
with  the  most  modern  and  approved  system  of  heating,  ventilation, 


CLINICAL    FACILITIES  36 

etc.,  and  equipped  with  all  modern  requirements  and  conveniences 
for  the  care  of  the  sick,  and  for  the  clinical  instruction  of  the  students 
of  the  University. 

It  is  one  of  the  largest  and  finest  hospitals  owned  and  controlled 
by  any  medical  school  in  America,  and  in  point  of  architectural  beauty, 
convenience  and  completeness  of  arrangements  and  equipment  com- 
pares favorably  with  other  hospitals. 

An  important  adjunct  to  the  hospital  is  the  postmortem  build- 
ing, which  is  constructed  with  special  reference  to  the  instruction 
of  students  in  pathological  anatomy. 

The  hospital  is  situated  opposite  the  University  building,  so  that 
the  student  loses  no  time  in  passing  from  the  lecture  halls  to  the 
clinical  amphitheater. 

A  portion  of  the  hospital  is  used  as  a  marine  hospital  for  foreign 
seamen.  The  great  importance  of  Baltimore  as  a  shipping  point 
brings  into  her  harbor  many  vessels  from  all  parts  of  the  world, 
and  the  sick  sailors  who  are  cared  for  in  the  wards  of  the  institution 
give  the  students .  an  opportunity  to  observe  a  large  variety  of 
diseases.  Another  considerable  portion  of  the  building  is  used  as  a 
Municipal  Hospital,  and  contains  charity  beds  supported  by  the  city 
of  Baltimore.  This  department  of  the  hospital  is  taxed  to  its  utmost 
capacity  to  afford  accommodations  for  the  patients  seeking  admission. 

Owing  to  its  location,  being  the  nearest  hospital  to  the  largest 
manufacturing  district  of  the  city,  the  University  Hospital  receives 
for  treatment  a  very  large  number  of  accident  cases  of  all  kinds,  both 
slight  and  serious.  These  cases,  as  well  as  patients  suffering  from 
the  various  diseases  of  our  own  climate,  occupy  the  beds,  and  add 
greatly  to  the  facilities  of  clinical  teaching  enjoyed  by  the  school. 
The  facihties  for  clinical  instruction  have  been  greatly  enlarged  by 
an  appropriation  by  the  State  of  Maryland  for  the  support  of  free 
beds  for  patients  from  the  various  counties. 

MERCY  HOSPITAL. 

The  Sisters  of  Mercy  first  assumed  charge  of  the  Hospital  at  the 
corner  of  Calvert  and  Saratoga  streets,  then  owned  by  the  Wash- 
ington University,  in  1875.  By  the  merger  of  1878  the  Hospital 
came  under  the  control  of  the  College  of  Physicians  and  Surgeons, 
but  the  Sisters  continued  their  work  of  ministering  to  the  patients. 

In  a  very  few  years  it  became  apparent  that  the  City  Hospital, 
as  it  was  then  called,  was  much  too  small  to  accommodate  the  rapidly 


36  CLINICAL   FACILITIES 

growing  demands  upon  it.  However,  it  was  not  until  1888  that  the 
Sisters  of  Mercy  with  the  assistance  of  the  Faculty  of  the  College  of 
Physicians  and  Surgeons,  were  able  to  lay  the  corner  stone  of  the 
present  Hospital.  This  building  was  completed  and  occupied  late 
in  1889.  Since  then  the  growing  demands  for  more  space  has  com- 
pelled the  erection  of  additions  until  now  there  are  accommodations 
for  351  patients. 

In  1909  the  name  was  changed  from  The  Baltimore  City  Hospital 
to  Mercy  Hospital. 

Mercy  Hospital  is  located  in  the  center  of  a  city  of  700,000 
inhabitants  and  is  under  the  exclusive  medical  control  of  the  College 
of  Physicians  and  Surgeons.  It  adjoins  the  College  building  and 
all  surgical  patients  from  the  public  wards  are  operated  upon  in  the 
College  operating  rooms.  This  union  of  the  Hospital  and  College 
buildings  greatly  facilitates  the  clinical  teaching  as  there  is  no  time 
lost  in  passing  from  one  to  the  other. 

Mercy  Hospital  is  the  hospital  of  the  United  Railways  and  Electric 
Company  of  Baltimore  City,  and  receives  patients  from  the  Balti- 
more and  Ohio  Railroad  Company  and  from  the  Pennsylvania 
Railroad  Company  and  its  branches. 

During  the  calendar  year  of  1915  there  were  treated  in  the  wards 
of  the  Hospital  5,084  patients.  That  the  emergency  service  is  very 
large  is  shown  by  the  fact  that  during  this  time  4,386  ambulant 
cases  were  treated  in  the  accident  department.  In  other  out-patient 
departments  there  were  treated  9,205  patients,  making  a  total  of 
18,675  ill  or  injured  people  who  applied  for  treatment  during  one  year. 

THE  MARYLAND  GENERAL  HOSPITAL. 

'  The  Maryland  General  Hospital  situated  at  Madison  Street  and 
Linden  Avenue  has  a  capacity  of  160  beds  and  furnishes  a  large 
amount  of  clinical  material  which  is  under  the  control  of  the  Faculty 
of  Physic  for  teaching  purposes. 

A  new  operating  suite  has  just  been  completed,  modern  in  every 
particular  and  adapted  to  the  teaching  of  small  sections  of  students. 
There  is  also  a  clinical  amphitheatre  for  larger  classes  of  students, 
in  close  proximity  to  the  wards.  The  hospital  treated  during  the 
last  fiscal  year  2980  patients  in  the  ward  and  2645  outdoor  patients. 
Eleven  hundred  and  seventy-two  surgical  operations  were  performed. 

The  hospital  receives  appropriations  from  the  State  of  Maryland 
and  the  City  of  Baltimore  for  the  support  of  charity  cases. 


CLINICAL    FACILITIES  37 

FRANKLIN  SQUARE  HOSPITAL. 

The  Franklin  Square  Hospital  has  a  capacity  of  100  beds. 
During  the  year  ending  October  1,  1915,  2528  cases  were  treated  in 
the  hospital,  and  2597  patients  were  treated  in  the  dispensary. 
Eight  hundred  surgical  operations  were  performed  in  the  hospital. 

LYING-IN  HOSPITALS. 
MATERNITY  HOSPITAL  OF  THE  UNIVERSITY  OF  MARYLAND. 

This  institution  is  also  the  property  of  the  Faculty  of  Physic,  and 
under  its  exclusive  control  and  direction,  and  is  conducted  with  the 
special  purpose  of  furnishing  actual  obstetrical  experience  to  each 
member  of  the  graduating  class. 

New  accommodations  have  been  provided  in  the  general  hospital, 
and  the  Maternity  Department  now  offers  better  facilities  than 
ever  before.  The  private  rooms  and  wards  are  modern  in  all  respects, 
and  the  large  increase  in  clinical  material  has  made  it  possible  to 
o.Ter  excellent  opportunities  for  post-graduate  work. 

MARYLAND  LYING-IN  HOSPITAL. 

This  hospital  adjoins  the  Maryland  General  Hospital  and  fur- 
nishes an  abundance  of  chnical  material  which  is  under  the  control 
of  the  Faculty  of  Physic. 

MARYLAND  LYING-IN  ASYLUM. 

This  hospital  was  established  by  the  College  of  Physicians  and 
Surgeons  in  1874.  It  is  the  pioneer  institution  of  its  kind  in  the 
State  of  Maryland  and  one  of  the  first  in  the  country. 

OUT-PATIENT  CLINIC  AND  DISPENSARIES. 

Each  of  the  above  hospitals  has  a  well  organized  out-patient 
department  and  dispensary,  under  supervision  of  graduates  in 
medicine  who  are  paid  instructors  and  devote  their  whole  time  to 
the  supervision  of  out-door  work. 

NUMBER  OF  PATIENTS. 

During  the  year  ending  May  1,  1916,  the  number  of  patients 
treated  in  the  Lying-In  hospitals  connected  with  the  School  was 
as  follows : 


38  CLINICAL    FACILITIES 

Number  of  Confinements  in  Hospitals •     969 

Number  of  Confinements,  Out-Patient  Department 1103 

Average  number  of  cases  seen  by  each  student  of  the  graduating  class.  .       35 

THE  MUNICIPAL  HOSPITALS— BAY  VIEW. 

The  clinical  advantages  of  the  University  have  been  largely 
increased  by  the  liberal  decision  of  the  Board  of  Supervisors  of 
City  Charities  to  allow  the  immense  material  of  these  hospitals 
to  be  used  for  the  purpose  of  medical  education.  There  are  daily 
visits  and  clinics  in  medicine  and  surgery  by  the  Staff  of  the  hos- 
pitals. The  autopsy  material  is  unsurpassed  in  this  country  in 
amount,  thoroughness  in  study,  and  the  use  made  of  it  in  medi- 
cal teaching. 

The  Municipal  Hospitals  consist  of  the  following  separate  hospitals : 

The  General  Hospital,  160  beds. 

The  Hospital  for  Chronic  Cases,  88  beds. 

The  Municipal  Hospital  for  Tuberculosis,  190  beds. 

City  Detention  Hospital  for  Insane,  450  beds. 

THE  PRESBYTERIAN  EAR,  EYE  AND  THROAT  CHARITY  HOSPITAL. 

This  institution,  which  was  founded  in  1877,  largely  through 
the  efforts  of  the  late  Dr.  J.  J.  Chisolm,  then  Professor  of  Diseases 
of  the  Eye  and  Ear  in  the  University  of  Maryland,  is  one  of  the 
largest  special  hospitals  in  the  country. 

During  the  year  1914  there  were  admitted  to  the  Dispensary 
and  Hospital,  11,688  persons. 

The  Dispensary  and  wards  of  this  hospital  afford  ample  facili- 
ties for  the  study  of  diseases  of  the  eye,  ear,  nose  and  throat. 

SOUTH  BALTIMORE  EYE,  EAR,  NOSE  AND  THROAT  CHARITY 

HOSPITAL. 

This  hospital,  situated  in  South  Baltimore,  occupies  a  new,  fire- 
{)roof  building,  with  a  capacity  of  45  beds,  of  which  25  are  ward 
beds.  It  has  a  large,  out-patient  department  devoted  to  diseases 
of  the  eye,  ear,  nose  and  throat.  Dr.  H.  E.  Peterman  is  visiting 
surgeon. 


CLINICAL    FACILITIES  39 

THE  JAMES  LAWRENCE  KERNAN  HOSPITAL  AND  INDUSTRIAL 
SCHOOL  OF  MARYLAND  FOR  CRIPPLED  CHILDREN. 

This  institution  contains  seventy-five  beds  for  the  active  treat- 
ment of  deformities.  It  is  situated  at  "Radnor  Park,"  a  colonial 
estate  of  sixty-five  acres  at  Hillsdale,  one  mile  from  the  western 
city  limits,  reached  by  trolley. 

This  institution  has  city,  state,  endowed  and  private  beds  and 
every  modern  facility  for  the  treatment  of  orthopedic  cases  as 
well  as  a  most  beautiful  park-like  environment  and  farm,  and  is 
closely  affiliated  with  the  University  of  Maryland. 

ST.  VINCENT'S  INFANT  ASYLUM. 

The  facilities  of  this  institution,  containing  250  infants  and  chil- 
dren, have  been  kindly  extended  to  the  University  of  Maryland 
by  the  Sisters  of  Charity.  This  large  clinic  enables  this  school 
to  present  to  its  students  liberal  opportunities  for  the  study  of  dis- 
eases of  infants  and  children. 

INSTITUTIONS  FOR  THE  TREATMENT  OF  THE  INSANE  AND  FEEBLE 

MINDED. 

The  Sheppard  and  Enoch  Pratt  Hospital  for  the  Insane 
This  institution  is  one  of  the  most  modern  hospitals  for  the  treatment 
and  care  of  the  insane  in  this  country,  it  is  well  endowed  and  its  super- 
intendent is  Dr.  Edward  N.  Brush,  Professor  of  Psychiatry  at  the 
University  of  Maryland.  In  this  hospital  intensive  treatment 
and  study  of  mental  diseases  is  carried  on;  a  large  number  of  the 
patients  entering  voluntarily.  The  students  under  the  direction 
of  Dr.  Brush  and  his  assistants  in  a  series  of  clinics  are  shown  the 
early  manifestations  and  the  various  stages  of  mental  diseases, 
the  methods  of  treatment,  and  their  effects. 

Mount  Hope  Retreat  for  the  Insane.  This  hospital  contains 
an  average  of  1000  patients,  is  attended  by  Dr.  Chas.  G.  Hill, 
A.M.,  M.D.,  Professor  of  Psychiatry  of  this  faculty.  Under  the 
direction  of  Dr.  Hill  and  his  assistants  the  students  are  given  op- 
portunity for  the  study  of  large  groups  of  patients  showing  all 
phases  of  various  mental  and  nervous  disorders. 

Spring  Grove  State  Hospital.  This  hospital,  a  state  institu- 
tion for  the  treatment  of  the  insane,  has  a  capacity  of  780  beds. 
Dr.  J.  Percy  Wade,  associate  in  Psychiatry,  is  the  superintendent. 


40  DISPENSARIES 

Students  of  this  school  are  given  a  limited  number  of  clinics  at 
this  institution. 

Springfield  State  Hospital.  This  large  stats  institution  for 
treatment  of  mental  diseases  is  situated  at  Sykesville,  Md.  Dr. 
J.  Clement  Clark,  Associate  Professor  of  Psychiatry  is  its  superintend- 
ent. There  are  accommodations  for  1400  patients.  At  this  in- 
stitution under  charge  of  a  capable  director  is  located  a  modern 
psychopathic  ward  where  intensive  study  of  the  various  mental 
diseases  is  carried  on.  Each  session  the  students  of  this  school  are 
given  several  clinics  by  Dr.  Clark  and  his  assistants. 

Rosewood  State  Training  School.  This  hospital  situated 
in  the  suburbs  of  Baltimore  is  owned  and  controlled  by  the  State 
of  Maryland.  It  contains  700  beds  devoted  to  the  treatment  and 
training  of  the  feeble  minded  and  epileptics.  Dr.  Frank  W.  Keat- 
ing is  the  superintendent  and  is  Instructor  in  Psycho-Asthenics 
in  the  University  of  Maryland.  Sections  of  the  Fourth  Year  class 
are  sent  to  this  hospital  for  instruction  in  the  proper  care  of  feeble 
minded  and   epileptics. 

DISPENSARIES. 

The  three  dispensaries  associated  with  the  University  Hospital, 
Mercy  Hospital  and  the  Maryland  General  Hospital  are  organized 
upon  a  uniform  plan  in  order  that  the  teaching  may  be  the  same  in 
all.  Each  dispensary  has  the  following  departments:  Medicine, 
Surgery,  Children,  F^ye  and  Ear,  Genito-Urinary,  Gynecology, 
Gastro-Enterology,  Neurology,  Orthopedics,  Proctology,  Derma- 
tology, Throat  and  Nose,  and  Tuberculosis. 

All  students  in  their  junior  year  work  in  the  departments  of 
Medicine  and  Surgery  each  day  in  one  of  the  dispensaries. 

All  students  in  their  senior  year  work  in  the  special  departments 
one  hour  each  day. 

Some  idea  of  the  value  of  these  dispensaries  for  clinical  teaching 
is  shown  by  the  number  of  patients  treated.  For  the  year  1915 
over  sixtj^-six  thousand  visits  were  made  to  the  dispensaries. 

In  addition  to  these  the  Dental  Department,  situated  upon  the 
grounds  of  the  University,  conducts  a  daily  clinic  which  is  open 
to  medical  students. 


DISPENSARY    REPORTS 


41 


University  Hospital  Dispensary  Report,  April,  1915  to  April,  1916 


DEPARTMENT 


Surgical 

Medical 

Nervous  Diseases. . 

Genito  Urinar}' 

Eye  and  Ear 

Women 

Children 

Skin 

Throat  and  Nose. .  . 

Stomach 

Tubercular 

Orthopedic 

Obstetrical 

Diseases  of  Rectum 


NEW  C.\SES 


1,674 
1,134 
316 
558 
786 
644 
605 
385 
529 
345 
345 
109 
231 
52 


7,713 


OLD  CASES 


4,082 

2,263 

2,539 

1,727 

1,096 

1,075 

931 

842 

645 

709 

616 

589 

74 

110 


17,298 


5,756 

3,397 

2,855 

2,285 

1,882 

1,719 

1,536 

1,227 

1,174 

1,054 

961 

698 

305 

162 


25,011 


Grand  Total  25,011 


John  Houff,  M.D., 

Dispensary  Physician. 


Mercy  Hospital  Dispensary  Report,  Jan.  1st,  1915  to  Dec.  31st,  1915 


Surgery 

Genito  Urinary .  . 

Stomach 

Nose  and  Throat 

Skin 

Gynecology 

Neurology 

General  Medicine 

Children 

Eye  and  Ear.  .  .  . 
Orthopedics 


NEW 

NO. 

P.^TIENTS 

VISITS 

1,4S0 

3,368 

1,007 

2,994 

571 

1,049 

545 

1,156 

491 

1,246 

690 

2,258 

451 

1,294 

1,526 

2,713 

612 

927 

612 

1,077 

70 

34 

8,085 

17,116 

TOTAL 
VISITS 


4,848 
4,001 
1,620 
1,701 
1,737 
1,918 
1,745 
4,239 
1,539 
l,fiS9 
104 

25,201 


B.  S.  Hanna,  INI.D., 

Resident  Physician. 


42  LABORATORIES 

LABORATORIES. 
ANATOMICAL  LABORATORIES. 

These  laboratories  are  in  charge  of  Dr.  Smith  and  his  assist- 
ants. The  University  has  recently  built  its  own  storage  and  em- 
balming plant,  which  supplies  an  abundance  of  anatomical  material. 
Dissecting  tickets  must  be  countersigned  as  evidence  of  satisfactory 
dissecting.  Anatomical  material  is  furnished  in  abundance,  free 
of  charge. 

CHEMICAL  LABORATORY. 

The  Chemical  Laboratory  is  under  the  supervision  of  Dr.  Simon, 
aided  by  the  Demonstrators.  Each  student  during  his  course  has 
assigned  him  a  tableland  is  fully  supplied,  with  all  necessary  appa- 
ratus and  chemicals,  free  of  charge,  except  for  breakage,  which  is 
charged  at  cost  price. 

Students  of  the  first  year's  class  will  be  required  to  devote  six- 
hours  weekly  to  work  in  this  department. 

LABORATORY  OF  EXPERIMENTAL  PHYSIOLOGY. 

This  laboratory  occupies  the  first  floor  of  Gray  Laboratory;  it 
includes  a  large  student  laboratory,  with  capacity  of  forty  students, 
a  room  completely  equipped  for  mammalian  experimentation,  a 
stock-room,  and  an  office  for  the  professor  in  charge.  Within  the 
same  building  there  is  an  animal  room  in  which  there  is  kept  a  con- 
stant supply  of  material  for  experimentation  and  demonstration. 
The  laboratory  is  equipped  with  ample  apparatus:  there  is  a  com- 
plete set  of  student  apparatus  available  for  each  group  of  two  stu- 
dents, while  the  special  apparatus  for  laboratory  experimentation 
and  class-room  demonstration  is  adequate  for.  the  needs  of  the 
courses. 

LABORATORY  OF  PHYSIOLOGICAL  CHEMISTRY. 

The  second  year  class  is  given  practical  instruction  in  the  chem- 
istry of  the  sugars  and  proteins  as  well  as  a  detailed  course  in  the 
chemistry  of  the  various  secretions.  The  experiments  performed 
b}^  each  student  are  adapted  to  illustrate  not  only  the  physiological 
but  also  the  pathological  conditions  which  may  result  in  various 
diseases  from  perverted  metabolism.  The  chemistry  of  the  food 
stuffs  and  its  practical  bearing  upon  diet  is  especially  dwelt  upon. 


LABORATORIES  ,      43 

The  course  is  essentially  practical,  only  including  so  much  theoretical 
physiology  as  is  necessary  for  a  proper  knowledge  of  the  subject. 
Graduates  and  advanced  students  competent  to  undertake  such 
work,  who  desire  to  pursue  special  chemical  investigation,  are  given 
the  opportunity  under  suitable  regulations. 

LABORATORY  OF  HISTOLOGY  AND  EMBRYOLOGY. 

This  laboratory  is  fully  equipped  for  teaching  Histology  and 
Embryology. 

There  is  a  large  collection  of  charts,  specimens  and  apparatus 
used  in  teaching.  The  necessary  equipment  for  the  practice  of 
technique  is  provided. 

LABORATORIES  OF  PATHOLOGY  AND  BACTERIOLOGY. 

The  subject  of  special  bacteriology  is  taught  during  a  portion  of 
the  second  year  in  a  well  equipped  laboratory  containing  sterilizers, 
water  baths,  and  other  necessary  equipment  for  this  purpose. 

The  subject  of  histopathology  is  also  taught  during  the  second 
year  in  a  properly  equipped  laboratory.  The  details  concerning 
this  work  are  described  under  the  subject  of  Department  of  Path- 
ology and  Bacteriology. 

The  instruction  in  gross  pathology  is  obtained  during  the  third 
year  by  attendance  upon  the  autopsies  at  the  University  Hospital, 
the  Mercy  Hospital,  and  the  Maryland  General  Hospital,  and 
special  instruction  in  this  subject  is  also  given  by  demonstrations  with 
a  large  amount  of  pathological  material  at  the  City  Hospitals  situ- 
ated at  Bay  View.  The  subject  of  gross  pathology  is  also  taught 
in  the  third  year  by  means  of  lectures  and  demonstrations  to  sec- 
tions of  the  third  year  class  and  a  special  effort  is  made  to  apply 
this  subject  to  the  explanation  of  the  symptoms  and  clinical  signs 
of  disease.  The  instruction  in  autopsy  technique  is  also  given 
personally  to  small  groups  of  students. 

LABORATORIES   OF  CLINICAL  PATHOLOGY. 

These  laboratories  are  fully  equipped  for  the  study  of  practical 
laboratory  work  in  its  relationship  to  clinical  medicine.  Each 
student  is  supplied  with  a  locker,  containing  a  microscope  and 
sufficient  apparatus  for  any  ordinary  examination. 


44      ,  LIBRARIES    AND    MUSEUM 

The  wards  and  out-patient  departments  of  the  hospitals  furnish 
an  abundance  of  material  for  study. 

By  reason  of  individual  equipment,  much  work  outside  of  class 
hours  is  expected  of  the  student. 

The  class  rooms  are  adequately  lighted,  and  are  conveniently 
situated  for  teaching  purposes. 

LIBRARIES. 

The  University  Library,  founded  in  1813  by  the  purchase  of  the 
collection  of  Dr.  John  Crawford,  now  contains  13,148  volumes, 
a  file  of  80  current  journals,  and  several  thousand  pamphlets  and 
reprints.  During  the  year  ending  June  1,  1916,  538  volumes  were 
added.  It  is  well  stocked  with  recent  literature,  including  books 
and  periodicals  of  general  interest.  The  home  of  the  Library  is 
Davidge  Hall,  a  comfortable  and  commodious  building  in  close 
proximity  to  the  class  rooms  and  the  laboratories  of  the  Medical 
Department.  The  Library  is  open  daily  during  the  year,  except 
in  August,  for  use  of  members  of  the  Faculty,  the  students,  and  the 
profession  generally. 

Other  libraries  of  Baltimore  are  the  Peabody  (181,000  volumes), 
the  Enoch  Pratt  Free  Library  (280,000  volumes)  and  the  Library 
of  the  Medical  and  Chirurgical  Faculty.  The  last  named  library 
receives  the  leading  medical  publications  of  the  world  and  complete 
sets  of  many  journals  are  available. 

The  libraries  are  open  to  students  of  the  Medical  School  without 
charge. 

The  proximity  of  Washington  puts  the  immense  libraries  of  the 
national  capital  at  the  disposal  of  students  of  this  school. 

THE  MUSEUM. 

The  museum  occupies  a  separate  apartment  in  the  main  building. 
It  is  under  the  care  of  the  curator.  Dr.  J.  Holmes  Smith  and  is 
assistants.  It  contains  a  large  collection  of  anatomical  preparations, 
plaster  casts,  charts,  models,  etc.,  used  in  teaching  anatomJ^  It 
contains  also  a  number  of  specimens  of  comparative  anatomy. 
There  is  a  large  collection  of  gross  pathological  specimens  and  cut 
sections  mounted  for  demonstration.  For  the  departmentof  obstet 
rics,  there  is  an  excellent  collection  of  normal  and  abnormal  human 
embryos. 


Al^^UAL   APPOINTMENTS  45 

PUBLICATIONS. 

Two  monthly  journals  are  published  by  the  University.  The 
University  Gazette  is  devoted  to  the  interests  of  the  entire  Univer- 
sity and  is  published  under  the  auspices  of  the. General  Alumni 
Association.  The  Bulletin  of  the  University  of  Maryland  School  of 
Medicine  and  College  of  Physicians  and  Surgeons  is  the  publication 
of  the  Medical  School.     Dr.  Nathan  Winslow  is  editor. 

ANNUAL  APPOINTMENTS. 

On  February  first  of  each  session  the  following  annual  appoint- 
ments are  made  from  among  the  graduates  of  the  school. 

TO    THE    UNIVERSITY    HOSPITAL. 

Medical  Superintendent. 
Six  Resident  Surgeons 
Four  Resident  Physicians. 
Two  Resident  Gynecologists. 
Two  Resident  Pathologists. 
Three  Resident  Obstetricians. 

A  number  of  students  are  appointed  each  year,  at  the  close  of 
the  session,  as  Clinical  Assistants  in  the  University  Hospital  for 
the  summer  months. 

TO   THE   MERCY   HOSPITAL. 

Medical  Superintendent. 
Six  Resident  Surgeons. 
Five  Resident  Physicians. 
One  Resident  Gynecologist. 
One  Resident  Obstetrician. 
Two  Accident  Service  Residents. 
One  Ambulance  Surgeon. 

TO   THE   MARYLAND    GENERAL   HOSPITAL. 

Medical  Superintendent. 
Ten  Resident  Physicians. 

This  hospital  has  a  rotating  service.  Each  resident  serves  a 
term  in  every  department,  including  the  pathological  laboratory, 
and  Maryland  Lying-in  Hospital. 

Many  appointments  to  other  hospitals  of  Baltimore  are  made 
annually,  to  which  graduates  of  this  school  are  eligible. 


46  REQUIREMENTS    FOR   MATRICULATION 

Each  student  in  the  fourth  year  class  is  required  to  spend  one 
trimester  as  resident  cHnical  assistant  in  the  University  Hospital 
without  extra  charge. 

PRIZES. 

Faculty  Prize — To  stimulate  study  among  the  candidates  for  graduation, 
the  Faculty  offers  a  Gold  Medal  to  the  candidate  who  passes  the  best  general 
examination.  Certificates  of  Honor  are  awarded  to  the  five  candidates  stand- 
ing next  highest. 

REQUIREMENTS  FOR  MATRICULATION. 

Admission  to  the  course  in  medicine  is  by  a  completed  Medical 
Student  Certificate  issued  by  the  Board  of  Medical  Examiners  of 
Maryland.  This  certificate  is  obtained  from  Prof.  Isaac  L.  Otis, 
the  Entrance  Examiner  of  the  Board,  on  the  basis  of  satisfactory 
credentials,  or  by  examination,  or  both,  and  is  essential  for  admis- 
sion to  any  class. 

The  requirements  for  the  issue  of  the  Medical  Student  Certificate 
are  those  prescribed  by  the  rules  of  the  Association  of  American 
Medical  Colleges,  of  which  Association  this  Faculty  is  a  member, 
and  comprise: 

(A)  The  completion  of  a  standard  four-year  high  school  course, 
or  its  equivalent,  and,  in  addition, 

(B)  One  year  of  college  credits  in  chemistry,  biology,  physics 
and  French  or  German. 

(A)     THE  HIGH  SCHOOL  REQUIREMENT. 

(1)  A  diploma  and  transcript  of  record  from  a  fully  accredited 
high  school,  normal  school  or  academy  requiring  for  admission 
evidence  of  the  completion  of  a  standai'd  course  in  primary  and 
intermediate  grades  and  for  graduation,  the  completion  of  a  standard 
four-year  high  school  course,  embracing  two  years  (2  units)  of  math- 
ematics, two  years  (2  units)  of  English,  two  years  (2  units)  of  a_ 
foreign  language,  one  year  (1  unit)  of  American  History  and  Civics 
and  seven  years  (7  units)  of  further  credit  in  language,  literature, 
history  or  science,  making  the  total  of  units  at  least  fourteen;  or, 

(2)  An  examination  in  the  following  branches  totaling  14  units: 


REQUIREMENTS    FOR   MATRICULATION  47 

(1)  Required,  7  units. 

Mathematics — (Minimum  2  years;  maximum  3  years)  Algebra  and   Units. 

Plane  Geometry 2 

English — (Minimum  2  years;  maximum  4  years) 2 

A  Foreign  Language — (Minimum  2  years;  maximum  4  years) 2 

U.  S.  History ,. 1 

Total  required  units 7 

(2)  Elective,  7  units.     To  be  selected  from  the  following: 

English 1 

Mathematics,  Algebra,  Solid  Geometry,  Trigonometry 1^ 

Latin,  Greek,  German,  French,  Spanish,  Scandinavian 13 

History  (foreign) 3 

Science,  Botany,  Zoology,  Chemistry,  etc 5 

Agriculture 1 

Drawing 1 

Manual  Training 1 

Domestic  Science 1 

Music 1 

"28i 

One  unit  in  any  subject  is  the  equivalent  of  work  in  that  subiect  for  four 
or  five  periods  per  week  for  a  year  of  at  least  thirty-six  weeks,  periods  to  be 
not  less  than  forty-five  minutes  in  length.  One  unit  is  equivalent  to  2  semester 
credits  or  2  points. 

(B)     THE  COLLEGE  REQUIREMENT. 

a.  The  preliminary  college  year  shall  extend  through  one  college 
session  of  at  least  thirty-two  weeks  of  actual  instruction,  including 
final  examinations. 

h.  In  excellence  of  teaching  and  in  content,  the  work  of  this  pre- 
liminary college  year  shall  be  equal  to  the  work  done  in  the  fresh- 
man year  in  standard  colleges  and  universities. 

c.  This  preliminary  college  year  shall  include  courses  in  physics, 
chemistry,  biology  and  German  or  French,  each  course  to  embrace 
at  least  eight  semester  hours  of  didactic  and  laboratory  work  in 
each  subject  as  shown  in  the  schedule  below,  provided  that  a  student 
may  satisfy  the  requirement  of  physics  in  presenting  one  unit  of 
high  school  physics  and  completing  a  half  year  of  college  physics 
which  continues  and  does  not  duplicate  the  work  done  in  the  high 
school. 

Provided  also,  that  a  student  may  satisfy  the  requirement  of 
French  or  German  by  presenting  two  units  of  regular  high  school 
work  in  either  language  and  completing  a  half  year  of  college  work 
in  that  language,  which  continues  and  does  not  duplicate  the  work 


48 


REQUIREMENTS    FOR   MATRICULATION 


done  in  the  high  school,  or  by  presenting  three  units  of  regular  high 
school  work  in  French  or  German. 

In  the  administration  of  the  entrance  requirements  of  the  pre- 
liminary college  year  conditions  may  be  allowed  until  September 
1917,  amounting  to  not  more  than  one-half  of  the  requirement  in 
physics  and  one-half  of  the  requirement  in  a  modern  language. 

Schedule 


aUBJECTT 

LECTURES  OR          LABORATORY 

RECITATIONS                 PERIODS 

PER  WEEK                PER  WEEK 

1 

TOTAL  HOURS        TOTAL  8EME8- 
PER                        TER  HODR8 
SEMESTER                 PER  YEAR 

Physics  (1) 

2                      2 

4                     8 

Chemistry  (1) 

2                       2 
2  or  3              2  or  1 

4                     8 

Bioloev  (1) 

4           '          8 

German  or  French  (2)  .  . . . 

4  or  3 

4  or  3              8  or  6 

Total 

10 

6  or  5 

16  or  15          32  or  30 

Each  laboratory  period  must  extend  over  at  least  two  hours. 


Or,  expressed  in  class  hours 


TOTAL  HOURS  TOTAL  HOURS 
LECTURES  OR  LABORATORY 
RECITATIONS  WORK 


TOTAL  MINI- 
MUM HOURS 
DIDACTIC  AND 
LABOBATOBT 


Physics  (1) 

Chemistry  (1) 

Biology  (1) 

German  or  French  (2) 

Total 


64  128 

64  128 

64  or  96  ,    128  or  64 

128  or  96 


320 


384  or  320 


192 

192 
128  or  160 
128  or  96 


704  or  640 


All  such  conditions  shall  be  removed  before  registration  for  the 
second  year. 

The  valuation  of  credentials  can  be  made  by  the  Entrance  Exam- 
iner only,  and  all  students  whose  entrance  qualifications  are  not 
clearly  satisfactory,  or  whose  certificates  are  not  complete,  are 
advised  to  obtain  from  him  or  from  the  Dean  blank  forms  on  which 
to  prepare  a  full  statement  of  their  previous  education,  in  advance  to 
their  coming  to  Baltimore.  Such  statements  to  be  submitted 
to  the  Entrance  Examiner  for  his  advice  as  to  the  course  to  be 
pursued. 


COMBINED    COURSE    IN   ARTS   AND    MEDICINE  49 

The  Entrance  Examiner  for  Maryland  is  Prof.  Isaac  L.  Otis, 
Lombard  and  Greene  Streets,  Baltimore.  To  him  must  be  sub- 
mitted the  credentials  of  all  applicants,  and  by  him  is  issued  the 
certificate  upon  which  the  student  is  matriculated. 

The  student  is  earnestly  advised  to  qualify  himself  under  his 
State  law,  and,  where  such  certificates  are  issued,  to  receive  the 
medical  students'  certificate  from  the  State  authorities  before  enter- 
ing upon  his  medical  studies.  By  adopting  this  course  difficulties 
may  be  avoided. 

Graduates  in  Medicine  desiring  to  take  the  Senior  Course,  with- 
out being  candidates  for  the  degree,  and  therefore  without  examina- 
tion, may  receive  a  certificate  of  attendance. 

After  January  1,  1918,  two  years  of  college  work  will  be  required 
for  admission  to  the  course  in  Medicine. 

COMBINED  COURSE  IN  ARTS  AND  MEDICINE. 

St.  John's  College,  Annapolis,  Md.,  founded  in  1696,  is  by  con- 
tract of  affiliation  styled  and  recognized  as  the  Department  of 
Arts  and  Sciences  of  the  University  of  Maryland. 

Students  who  have  completed  the  Junior  Year  in  St.  John's 
College  and  who  have  made  an  approved  choice  of  electives  may 
if  they  desire  it  do  the  entire  work  of  the  Senior  Year  in  the  Medical 
School  of  the  University.  If  they  successfully  complete  the  work 
of  the  first  medical  year  they  are  graduated  with  their  class  with 
the  degree  of  A.B.,  from  St.  John's  College. 

By  taking  advantage  of  this  privilege  a  man  may  complete  the 
Undergraduate  and  Medical  courses  in  seven  years. 

During  three  of  these  years  or  until  he  has  completed  the  work 
of  the  Junior  class  he  is  a  resident  student  in  St.  John's  College  and 
for  four  years  he  is  a  resident  in  the  Medical  School  in  Baltimore. 

At  the  end  of  the  fourth  year  he  receives  the  A.B.  degree,  and  at 
the  end  of  the  seventh  year  the  M.D.  degree,  but  credit  from  the 
Medical  School  cannot  be  accepted  in  subjects  for  which  credit 
has  already  been  given  in  the  College  of  Liberal  Arts. 

In  order  to  meet  the  increased  requirements  for  matriculation 
taking  effect  January  1,  1914,  a  special  Pre-Medical  Course  in 
Chemistry,  Physics,  Biology  and  French  or  German  is  now  offered 
in  St.  John's  College. 


50  RULES 

GRADUATES  OF  PHARMACY. 

Graduates  of  recognized  Colleges  of  Pharmacy  will  be  given  credit 
for  the  work  which  they  have  done  in  Chemistry  and  Materia  Medica 
and  will  be  excused  from  the  lectures,  laboratory  work  and  recita- 
tions upon  these  subjects  in  the  Freshman  Year.  The  fee  for  the 
Freshman  Year  to  Graduates  of  Pharmacy  will  be  $125. 

RULES. 

1.  Tickets  for  practical  anatomy  must  be  countersigned  by  the 
proper  demonstrators.  Unless  properly  countersigned,  a  ticket 
will  not  be  accepted  as  evidence  of  a  completed  course. 

2.  All  students  are  required  to  stand  the  spring  examinations 
unless  excused  by  the  Dean.  No  student  will  be  permitted  to  enter 
the  third-year  class  who  has  not  completed  all  first-year  work,  and 
no  student  will  be  permitted  to  enter  the  fourth-year  class  who  has 
not  completed  all  second-year  work,  nor  shall  a  student  be  ad- 
vanced from  a  lower  to  a  higher  class  if  he  is  conditioned  in  more 
than  one  major  and  one  minor  subject. 

3.  The  graduation  fee,  which  is  $30,  must  be  deposited  with  the 
Dean  before  the  candidate  can  be  admitted  to  final  examination. 
This  fee  is  returned  in  case  the  examination  is  unsuccessful. 

4.  Should  a  student  be  required  to  repeat  any  year  in  the  course 
he  must  psiy  regular  fees. 

5.  A  student  failing  in  final  examination  for  graduation  at  the  end 
of  the  fourth  year  will  be  required  to  repeat  the  entire  course  of  the 
fourth  year  and  to  take  examinations  in  such  other  branches  as  may 
be  required,  should  he  be  again  permitted  to  enter  the  school  as  a 
candidate  for  graduation. 

6.  Students  are  required  to  pay  for  breakage  and  to  make  a  de- 
posit on  this  account.  The  unexpended  balance  will  be  returned 
at  the  end  of  the  session. 

7.  The  general  fitness  of  a  candidate  for  graduation  will  be  taken 
into  consideration  by  the  Faculty  as  well  as  the  results  of  his  final 
examination. 

Al  the  above  rules,  as  well  as  the  fees  stated  below,  relate  to  the 
year  ending  June  1,  1917,  only.  The  right  is  reserved  to  make 
changes  in  the  curriculum,  requirements  for  graduation,  fees  and 
all  the  regulations  whenever  the  Faculty  deem  it  expedient. 


SCHOLARSHIPS  51 

FEES. 

Matriculation  fee  (paid  each  year) $5.00 

Tuition  fee  (each  year) 165 .  00 

Graduation  fee 30 .  00 

There  are  no  extra  charges  for  instruction  in  any  department, 
or  for  laboratory  courses,  except  for  breakage,  and  in  special  cases 
for  materials  consumed. 

Tuition  fees  are  due  and  payable  during  October,  and  if  the  en- 
tire amount  is  paid  at  the  Dean's  office  before  November  1,  the  tui- 
tion fee  for  that  year  will  be  $160. 

The  above  fees  apply  to  all  students  who  matriculate  in  this 
institution  for  the  first  time,  in  any  class,  for  the  session  beginning 
October  1,  1915. 

Students  who  have  already  attended  one  or  more  full  courses  of 
instruction  in  this  institution  will  be  entitled  to  complete  the  course 
in  medicine  at  the  current  rates  in  force  at  the  time  of  their  first 
full  course  of  lectures  in  this  institution. 

Fees  for  individual  courses  not  less  than  $25  each. 

SCHOLARSHIPS. 

The  Dr.  Samuel  Leon  Frank  Scholarship. 

This  scholarship,  established  by  Mrs.  Bertha  R,ayner  Frank  as 
a  memorial  of  the  late  Dr.  Samuel  Leon  Frank,  an  alumnus  of  this 
University,  entitles  the  holder  to  exemption  from  the  payment 
of  the  tuition  fee  of  that  year. 

It  is  awarded  by  the  Trustees  of  the  Endowment  Fund  of  the 
University  in  each  year  upon  nomination  of  the  Faculty  of  Physic, 
"to  a  medical  student  of  the  University  of  Maryland,  who  in  the 
judgment  of  said  Faculty,  is  of  good  character,  and  in  need  of  pe- 
cuniary assistance  to  continue  his  medical  course." 

This  scholarship  is  awarded  to  a  second,  third  or  fourth  year 
student  only,  who  has  successfully  completed  one  year's  work  in 
the  medical  course,  and  no  student  may  hold  such  scholarship  for 
more  than  two  years. 

The  Charles  M.  Hitchcock  Scholarships. 

From  a  bequest  to  the  School  of  Medicine  by  the  late  Charles 
M.  Hitchcock,  M.D.,  an  alumnus  of  the  University,  two  scholarships 
have  been  established  which  entitle  the  holders  to  exemption  from 
payment  of  tuition  fees  for  the  year. 


52  NOTICE    TO    STUDENTS 

These  scholarships  are  awarded  annually  by  the  Faculty  of  Physic 
to  students  who  have  meritoriously  completed  the  work  of  at  least 
the  first  year  of  the  course  in  medicine,  and  who  present  to  the. 
Faculty  satisfactory  evidence  of  good  moral  character,  and  of 
inability  to  continue  the  course  without  pecuniary  assistance. 

The  Randolph  Winslow  Scholarship. 

This  scholarship,  established  by  Prof.  Randolph  Winslow,  M.D., 
LL.D.,  entitles  the  holder  to  exemption  from  the  payment  of  the 
tuition  fee  of  that  year. 

It  is  awarded  annually  by  the  Trustees  of  the  Endowment  Fund 
of  the  University,  upon  nomination  of  the  Faculty  of  Physic,  to 
"a  needy  student  of  the  Senior,  Junior,  or  Sophomore  Class  of  the 
Medical  School. 

"He  must  have  maintained  an  average  grade  of  85%  in  all  his 
work  up  to  the  time  of  awarding  the  scholarship. 

"He  must  be  a  person  of  good  character  and  must  satisfy  the 
Faculty  of  Physic  that  he  is  worthy  of  and  in  need  of  assistance." 

The  University  Scholarship. 

This  scholarship,  which  entitles  the  holder  to  exemption  from 
payment  of  the  tuition  fee  of  the  year,  is  awarded  annually  by 
the  Faculty  of  Physic  to  a  student  of  the  Senior  Class  who  presents 
to  the  Faculty  satisfactory  evidence  of  good  moral  character,  and 
that  he  is  worthy  of  and  in  need  of  assistance  to  complete  the  course. 

The  St.  John's  Scholarship. 

This  scholarship  is  awarded  annually  by  the  Facult}''  of  Physic 
upon  the  nomination  of  the  President  of  St.  John's  College. 

It  entitles  the  holder  to  exemption  from  the  pajaiient  of  the 
tuition  fee  of  that  year. 

NOTICE  TO  STUDENTS 

The  personal  expenses  of  students  are  at  least  as  low  in  Baltimore 
as  in  any  large  city  in  the  United  States.  The  following  estimates 
of  student's  personal  expenses  for  the  academic  year  of  eight  months 
have  been  prepared  by  students,  and  are  based  upon  actual 
experience: 


ORGANIZATION    OF   THE    CURRICULUM 


53 


Items. 

Low. 

Average. 

Liberal. 

Books 

College  Incidentals 

$  IS 

96 
48 
35 
10 

$  32 

5 

112 

65 

50 

20 

$  50 
10 

Board,  eight  months 

Room  rent 

128 
80 

Clothing  and  washing — 

All  other  expenses 

100 
75 

Total; 

$207 

$284 

$443 

Students  will  save  time  and  expense  upon  their  arrival  in  the 
city  by  going  direct  to  the  School  of  Medicine  on  the  University 
grounds,  N.E.  corner  of  Lombard  and  Greene  Streets,  where  the 
Superintendent  of  Buildings,  who  may  be  found  at  his  office  on  the 
premises,  will  furnish  them  with  a  list  of  comfortable  and  convenient 
boarding  houses  suitable  to  their  means  and  wishes. 

The  Dean  will,  if  desired,  attend  to  the  collection  of  checks  and 
drafts  for  students. 

For  further  information  apply  to  either 

J.  M.  H.  Rowland,  M.  D.,  Dean, 
Caleb    Winslow,   A.M.,    Registrar. 

Lombard  and  Greene  Streets. 


ORGANIZATION  OF  THE  CURRICULUM. 

The  following  curriculum  is  the  result  of  a  recent  and  thorough 
revision  of  teaching  in  this  school  in  order  to  meet  modern  require^ 
ments.  The  multiplication  of  specialties  in  medicine  and  surgery 
necessitates  a  very  crowded  course  and  the  question  of  electives  is 
one  which  very  soon  will  be  depended  on  to  solve  some  of  the 
difficulties. 

The  curriculum  is  organized  under  ten  departments. 

1 .  Anatomy  (including  Histology  and  Embryology) . 

2.  Physiology. 

3.  Chemistry  including  Physiological  Chemistry. 

4.  Materia  Medica  and  Pharmacology. 

5.  Pathology  and  Bacteriology. 

6.  Medicine  (including  Medical  Specialties). 

7.  Surgery  (including  Surgical  Specialties). 

8.  Obstetrics. 


54  ORGANIZATION    OF   THE    CURRICULUM 

9.  Gynecology. 

10.  Ophthalmology  and  Otology. 

The  instruction  is  given  in  four  years  of  graded  work. 

Several  courses  of  study  extend  through  two  years  or  more,  but 
in  no  case  are  the  students  of  different  years  thrown  together  in 
the  same  course  of  teaching. 

The  first  and  second  years  are  devoted  largely  to  the  study  of 
the  structures  and  functions  of  the  normal  body  and  laboratory 
work  occupies  most  of  the  student's  time  during  these  two  years. 

Some  introductory  instruction  in  Medicine  and  Surgery  is  given 
in  the  second  year.  The  third  and  fourth  years  are  almost  entirely 
clinical. 

A  special  feature  of  instruction  in  the  school  is  the  attempt  to 
bring  together  teacher  and  student  in  close  personal  relationship. 
In  many  courses  of  instruction  the  classes  are  divided  into  small 
groups  and  a  large  number  of  teachers  insures  attention  to  the 
needs  of  each  student. 

In  many  courses  the  final  examinations  as  the  sole  test  of  pro- 
ficiency has  disappeared  and  the  student's  final  grade  is  determined 
largely  by  partial  examinations,  recitations  and  assigned  work 
carried  on  throughout  the  course. 

ARRANGEMENT  OF  CLASSES. 

All  the  teaching  of  the  freshman  class  is  done  at  Calvert  and 
Saratoga  Streets.  All  the  teaching  of  the  sophomore  class  is  done 
at  Lombard  and  Greene  Streets. 

The  junior  class  has  two  hours  of  didactic  teaching  each  morning. 
For  clinical  instruction  and  laboratory  work  this  class  is  divided  into 
two  sections  and  the  year  into  semesters.  Each  section  will  work 
for  one  semester  at  the  University  Hospital  and  one  semester  at 
Mercy  Hospital. 

The  senior  class  is  divided  into  three  sections  and  for  this  class 
the  year  is  divided  into  trimesters.  Each  section  receives  clinical 
instruction  for  one  trimester  in  the  University  Hospital,  Mercy  Hos- 
pital and  the  Maryland  General  Hospital.  Each  section  when 
assigned  to  the  University  Hospital  will  be  given  rooms  adjacent 
to  the  hospital  without  additional  charge.  In  the  afternoon  the 
whole  class  is  assembled  and  has  two  hours  of  didactic  teaching  each 
day. 

This  distribution  of  the  classes  is  made  in  order  to  utilize  to  the 
best  advantage  the  laboratory  space  and  to  bring  the  students  into 


ORGANIZATION    OF   THE    CURRICULUM  55 

daily  contact  with  patients  in  all  three  of  the  large  hospitals  and 
dispensaries. 

DEPARTMENT  OF  ANATOMY  INCLUDING  HISTOLOGY  AND 
EMBRYOLOGY. 

J.  Holmes  Smith,  M.D Professor  of  Anatomy 

A.  C.  Pole,  M.D Professor  of  Descriptive  Anatomy 

TiLGHMAN  B.  Harden,  A.B.,  M.D. 

Professor  of  Histology  and  Embryology  and  Assistant  in  Anatomy 

J.  W.  Holland,  M.D Associate  Professor  of  Anatomy 

J.  L.  Wright,  M.D Associate  in  Anatomy  and  Histology 

Fred.  Rankin,  A.M.,  M.D Assistant  in  Anatomy 

F.  L.  Jennings,  M.D Assistant  in  Anatomy 

Wm.  R.  Geraghty,  M.D Assistant  in  Anatomy 

First  Year.  Didactic.  Three  hours  each  week  for  thirty- 
two  weeks. 

This  course  embraces  the  integuments,  myology,  angiology, 
osteology,  syndesmology  and  the  peripheral  nerves. 

Laboratory.  Ten  hours  each  week  for  thirty-two  weeks.  Abun- 
dance of  good  material  is  furnished  and  the  student  is  aided  in  his 
work  by  competent  demonstrators.  Examinations  are  held  at 
regular  intervals  throughout  the  session,  and  each  student  will  be 
held  to  strict  account  for  material  furnished  him. 

Osteology.  Two  hours  each  week  for  thirty-two  weeks.  Lec- 
tures, demonstrations,  and  recitations.  Each  student  is  furnished 
a  skeleton  and  a  deposit  is  required  to  insure  its  return  at  the  end 
of  the  session. 

Second  Year.  Didactic.  Three  hours  each  week  for  thirty- 
two  weeks.     Lectures,  recitations  and  conferences. 

Laboratory.  Ten  hours  each  week  for  sixteen  weeks.  This 
course  includes  topographical  and  applied  anatomy  of  the  body 
cavities  and  viscera  and  the  cerebro-spinal  and  sympathetic  ner- 
vous systems  with  special  demonstrations  of  important  subjects 
to  the  class  in  small  sections. 

The  teaching  of  anatomy  is  illustrated  by  means  of  charts,  dia- 
grams, special  dissections  and  the  projection  apparatus. 

Histology. 

First  Year.  Lectures,  recitations  and  laboratory  work,  nine 
hours  each  week  during  first  semester;  three  hours  each  week  dur- 
ing second  semester.     The  most  important  part  of  the  work  will  be 


56  ORGANIZATION    OF    THE    CURRICULUM 

done  in  the  laboratory,  where  each  student  will  be  provided  with  a 
microscope,  apparatus,  staining  fluids  and  material  necessary  for 
the  preparation  of  specimens  for  microscopical  examination.  An 
important  aid  to  the  course  is  the  projection  microscope  which  is 
used  for  the  projection  upon  a  screen  of  magnified  images  of  the 
specimens  actually  used  in  the  laboratory. 

Embryology. 

Lectures,  recitations  and  laboratory  work;  six  hours  each  week 
during  the  second  semester. 

This  course  includes  the  study  of  the  development  of  the  chick, 
and  the  fundamental  principles  of  mammalian  embryology.  In 
the  laboratory,  the  hen's  egg  will  be  studied  in  its  various  stages 
of  development,  and  sections  of  the  chick  at  different  periods  of 
incubation  will  be  made  and  studied  microscopically.  The  latter 
part  of  the  course  will  be  devoted  to  the  study  of  sections  through 
different  regions  of  a  mammal. 

DEPARTMENT  OF  PHYSIOLOGY. 

John  C.  Hemmeter,  M.D.,  Ph.D.,  Sc.D.,  LL.D Professor  of  Physiology 

Bartgis  McGlone,  A.B.,  Ph.D Professor  of  Physiology 

Charles  C.  Conser,  M.D '..,.....  .Associate  Professor  of  Physiology 

G.  W.  Hemmeter,  M.D Associate  in  Physiology 

FiRMADGE  K.  Nichols,  A.B.,  M.D Associate  in  Physiology 

Henry  T.  Collenberg,  A.B.,  M.D Associate  in  Physiology 

The  course  in  Physiology  extends  throughout  the  First  and  Second 
Years.  It  consists  of  a  series  of  lectures,  covering  the  field  of  human 
physiology,  laboratory  work,  demonstrations,  and  frequent  recita- 
tions. It  is  constantly  in  the  mind  of  the  department  that  this 
course  is  introductory  to  the  study  of  medicine.  The  recitations 
cover  the  subject-matter  of  the  lectures  and  the  experiments  per- 
formed in  the  laboratory. 

First  Year.  1.  This  course  includes  lectures  and  recitations 
upon  the  physiology  of  the  blood  and  circulation,  muscle  and  nerve, 
a  portion  of  the  central  nervous  system,  and  special  senses,  and  such 
chemical  and  physical  facts  as  are  necessary  for  a  proper  understand- 
ing of  the  physiology  taught.  Two  lectures  and  a  recitation  weekly 
throughout  the  year.     Dr.  McGlone. 

Second  Year.  2.  Didactic  instruction.  During  this  year  the 
remaining  topics  of  physiology  are  covered  by  lectures  and  demon- 


ORGANIZATION    OF   THE    CURRICULUM  57 

strations.  As  in  the  first  year  frequent  recitations  will  be  held. 
The  subject-matter  includes  the  physiology  of  respiration,  digestion 
and  secretion,  nutrition,  eye  and  ear,  and  the  cranial  central  nervous 
system.  Lectures,  demonstrations,  and  recitations,  three  hours 
per  week.     Dr.  Hemmeter,  assisted  by  Drs.  Conser  or  McGlone. 

3.  Experimental  Physiology.  This  is  a  laboratory  course  in  the 
dynamics  of  muscle  and  nerve,  studies  in  circulation  and  respiration, 
and  physiology  of  the  special  senses.  Apart  from  the  acquisition  of 
the  facts  of  physiology,  the  student  is  taught  to  observe  accurately, 
record  carefully  the  results  of  his  observations,  and  from  these  re- 
sults draw  an  independent  conclusion.  He  is  also  trained  in  the 
use  of  instruments  which  are  of  value  to  him  in  his  clinical  years. 
Three  hours  weekly  throughout  the  year.  Drs.  McGlone,  Conser, 
Nichols  and  Collenberg. 

4.  Special  Mammalian  Physiology.  This  is  a  Laboratory  course 
intended  for  advanced  Laboratory  students  (optional)  who  may 
wish  to  do  special  work  in  this  line  of  physiology.  Hours  to  be 
arranged.     Dr.  McGlone. 

5.  Research  in  Physiology.  Properly  qualified  students  will  be 
admitted  to  the  laboratory  which  is  well  adapted  for  post-graduate 
study  and  special  research.  Hours  will  be  arranged  to  suit  in- 
dividuals.    Dr,  John  C.  Hemmeter. 

DEPARTMENT  OF  CHEMISTRY. 

Charles  E.  Simon,  A.B.,  M.D Professor  of  Physiological  Chemistry 

G.  Howard  White,  A. B.,  MD.  Associate  Professor  of  Physiological  Chemistry 

E.  F.  Kelly,  Phar.D Associate  Professor  of  Chemistry 

H.  Boyd  Wylie,  M.D Associate  Professor  of  Physiological  Chemistry 

First  Year  Organic  Chemistry.  L  Lectures  and  Recitations; 
two  hours  per  week  throughout  the  session. 

The  method  adopted  for  the  study  of  carbon  compounds  is  to 
lead  the  student  from  the  consideration  of  the  most  simply  consti- 
tuted bodies  to  those  of  more  and  more  complex  composition.  Much 
stress  will  be  laid  on  the  reasons  which  justify  the  adoption  of  the 
prevalent  views  in  regard  to  the  structure  of  carbon  compounds. 
During  the  study  of  the  various  groups  those  substances  which  are 
of  more  general  interest  to  the  medical  student  will  be  specially 
considered. 

2.  Laboratory  work     Four  hours  per  week  during  the   session. 

A  course  of  carefully  selected  experiments,  performed  by  the 
student  in  the  laboratory  serves  to  impart  a  clear  idea  of  the  mani- 


58  ORGANIZATION    OF    THE    CURRICULUM 

fold  changes  which  organic  compounds  undergo.  He  learns  here 
much  by  witnessing  the  actual  building  up  of  complex  carbon  com- 
pounds by  synthetical  methods  and  sees  the  breaking  down  of  others 
into  simpler  forms  of  matter. 

Second  Year.  Organic  and  Physiological  Chemistry.  1.  Lec- 
tures and  recitations.     One  hour  per  week  throughout  the  session. 

This  course  includes  the  study  of  general  organic  chemistry  with 
special  attention  to  the  more  important  carbon  compounds  which 
are  of  particular  importance  to  the  student  of  medicine,  with  refer- 
ence to  their  relations  to  physiology,  pathology  and  clinical  medicine. 

2.  Laboratory  Work.     Six  hours  per  week  for  one  semester. 

This  includes  a- study  of  the  properties  of  the  food  stuffs,  their 
decomposition  and  metabolic  products,  digestion,  the  blood,  chem- 
istry of  the  secretions  and  excretions,  and  the  various  abnormal 
compounds  resulting  from  perverted  metabolism.  The  student 
will  be  expected  to  familiarize  himself  with  the  manipulation  of  the 
apparatus  in  use  in  the  study  of  the  various  secretions,  excretions 
and  fluids  of  the  body. 

DEPARTMENT  OF  MATERIA  MEDICA  AND  PHARMACOLOGY. 

Samuel  J.  Fort,  M.D Professor  of  Materia  Medica  and  Pharmacology 

H.  L.  SiNSKEY,  M.D Associate  in  Materia  Medica 

H.  Boyd  Wylie,  M.D Associate  in  Pharmacology 

First  Year.  Two  hours  per  week  throughout  the  session,  didac- 
tic lectures  on  Materia  Medica.     Dr.  Fort. 

A  laboratory  course  in  Pharmacy  and  prescription  writing,  two 
hours  per  week.     Dr.  Sinsky. 

Second  Year.  Two  hours  per  week  throughout  the  session  on 
Pharmacology.     Dr.  Fort. 

A  laboratory  course  of  two  hours  per  week  throughout  the  session, 
on  the  physiological  and  toxicological  action  of  the  more  important 
drugs.     Dr.  Wylie. 

DEPARTMENT  OF  PATHOLOGY  AND  BACTERIOLOGY. 

Wm.  Royal  Stokes,  M.D Professor  of  Pathology  and  Bacteriology 

Standish  McCleary,  M.D Professor  of  Pathology 

H.  R.  Spencer,  M.D..  .Associate  Professor  of  Pathology  and  Bacteriology 
Wm.  Greenfeld,  M.D.. .  .Associate  Professor  of  Pathology  and  Bacteriology 
Caleb  W.  G.  Rohrer,  A.M.,  M.D.,  PhD.  .  .Associate  Professor  of  Pathology 

Harry  W.  Stoker,  M.D Associate  in  Pathology  and  Bacteriology 

Frank  W.  Hachtel,  M.D Associate  in  Bacteriology 


ORGANIZATION    OF    THE    CURRICULUM  59 

Instruction  in  histopathology  and  in  special  bacteriology  is  given 
in  the  laboratories  to  the  students  of  the  second  year  The  course 
in  histopathology  includes  the  demonstrations  of  the  common 
lesions  of  the  various  viscera,  and  the  subject  of  general  pathology 
including  inflammation,  degeneration  and  infiltration  and  tumors. 
The  typical  gross  lesions  are  also  exhibited  during  this  course. 

In  special  bacteriology  the  various  methods  of  sterilization  and 
preparation  of  culture  material,  the  study  of  the  pathogenic  micro- 
organisms both  of  animal  and  vegetable  origin,  and  the  bacteriologi- 
cal study  of  milk,  water,  sewage  and  other  such  materials,  are  given. 
The  bacteriological  diagnosis  of  the  infectious  diseases  is  also  included 
in  this  course.  Animal  inoculations  and  autopsies  are  performed 
in  connection  with  the  bacteria  studied,  and  the  diagnoses  by  means 
of  serum  reactions  are  also  given. 

In  the  third  year  the  subject  of  gross  pathology  is  taught  by  means 
of  museum  specimens  to  groups  of  students,  and  the  special  relation- 
ship of  gross  and  microscopic  lesions  to  clinical  symptoms  and  signs 
of  disease  is  especially  emphasized.  Autopsy  technique  is  also 
taught  to  small  groups  of  students  by  special  instruction  at  the  autop- 
sies performed  at  the  various  hospitals,  and  the  specimens  obtained 
at  such  autopsies  are  demonstrated  to  the  entire  class.  Vaccine 
therapy  and  the  animal  parasites  are  also  taught  in  this  year. 

In  the  fourth  year  the  specimens  from  autopsies  are  studied  with 
reference  to  clinical  histories  and  gross  and  microscopic  anatomy. 
Special  emphasis  is  laid  upon  the  correlation  of  the  anatomical 
findings  with  the  clinical  symptoms  and  diagnosis.  The  demonstra- 
tions are  also  illustrated  with  sections  of  fixed  material  by  means  of 
lantern  slides. 

Courses  in  surgical  and  gynecological  pathology  are  also  given  to 
the  fourth  year  students,  but  these  courses  are  under  the  direction 
of  the  Departments  of  Surgery  and  Gynecology. 

MEDICAL  JURISPRUDENCE  AND  HYGIENE. 

Nathaniel  G.  Keirle,  A.M.,  M.D.,  Sc.D.,  LL.D. 

Professor  of  Medical  Jurisprudence 
Joseph  T.  Smith,  M.D Professor  of  Hygiene 

Second  Year.     One  hour  each  week  for  entire  session. 

Medical  Jurisprudence.  This  course  embraces  consideration  of 
medical  evidence  and  testimony,  confidential  communications, 
malpractice,  indications  of  death,  pregnancy,  delivery,  infanticide 
and  insanity. 


60  CLINICAL    INSTRUCTION 

CTJNK  AL  INSTRUCTION. 

DEPARTMENT  OF  SURGERY. 

Randolph  Winslow,  A.M.,  M.D.,  LL.D Professor  of  Surgery 

Arthur  M.  Shipley,  M.D Professor  of  Surgery 

RiDGELY  B.  Warfield,  M.D Professor  of  Surgery 

John  W.  Chambers,  M.D.,  Sc.D Professor  of  Surgery 

Archibald  C.  Harrison,  M.D Professor  of  Surgery 

Frank  Martin,  B.S.,  M.D Professor  of  Clinical  and  Operative  Surgery 

J.  D.  Blake,  M.D Professor  of  Clinical  Surgery 

Alexius  McGlannan,  A.M.,  M.D. 

Professor  of  Clinical  Surgery  and  Surgical  Pathology 

Joseph  H.  Branham,  M.D Professor  of  Clinical  Surgery 

Albert  T.  Chambers,  M.D Professor  of  Clinical  Surgery 

John  G.  Jay,  M.D Clinical  Professor  of  Surgery 

Nathan  Winslow,  A.M.,  M.D Clinical  Professor  of  Surgery 

Alfred  Ullman,  M.D Clinical  Professor  of  Surgery 

Walter  D.  Wise,  M.D Clinical  Professor  of  Surgery 

Joseph  W.  Holland,  M.D Associate  Professor  of  Clinical  Surgery 

William  W.  Requardt,  M.D Associate  Professor  of  Surgery 

J.  C.  Lumpkin,  M.D Associate  Professor  of  Clinical  Surgery 

H.  C.  Blake,  M.D Associate  Professor  of  Cliincal  Surgery 

Robert  P.  Bay,  M.D Associate  Professor  of  Clinical  Surgery 

Frank  S.  Lynn,  M.D Associate  Professor  of  Surgerj'^ 

Elliott  H.  Hutchins,  A.M.,  M.D Associate  Professor  of  Surgery 

Thomas  R.  Chambers,  A.B.,  IVLD Associate  Professor  of  Surgery 

Harvey  B.  Stone,  A.B.,  M.D Associate  Professor  of  Surgery 

R.  W.  Locher,  M.D. .  .Associate  Professor  of  Operative  and  Clinical  Surgery 

Arthur  G.  Barrett,  M.D Associate  in  Surgery 

Frank  J.  Kirby,  M.D Associate  in  Surgery 

Fred  Rankin,  A.M.,  M.D Associate  in  Surgery 

B.  M.  Bernheim,  A.B.,  M.D Lecturer  on  Blood  Vessel  Surgery 

Howard  D.  Lewis,  M.D Instructor  in  Surgery 

F.  L.  Jennings,  M.D Instructor  in  Surgery 

A.  M.  Evans,  M.  D Assistant  in  Surgery 

The  course  in  surgery  is  progressive,  and  aims  to  ground  the  stu- 
dent firmly  in  the  principals  of  surgical  science  in  order  that  later 
he  may  be  prepared  to  build  upon  a  firm  foundation  the  superstruc- 
ture of  surgical  art. 

Second  Year.  During  this  year  a  practical  course  of  bandaging 
is  given  upon  the  manikin;  the  student  being  required  to  apply  person- 
ally the  various  forms  of  bandages  to  the  different  parts  of  the  body. 

Third  Year.     Surgical    Pathology    and    Principles    of   Surgery. 


CLINICAL    INSTRUCTION  61 

Lectures,  recitations  and  clinics,  three  hours  weekly.  Drs.  Shipley 
and  War  field. 

The  class  is  divided  in  sections  and  receives  instruction  in  history 
taking,  gross  surgical  pathology  and  surgical  diagnosis  at  the  bed- 
side and  in  the  dead  house  in  the  City  Hospitals  at  Bay  View.  Drs. 
Shipley  and  Lynn. 

Operative  Surgery.  Instruction  is  given  in  operative  surgery  upon 
the  cadaver  and  on  dogs.  The  class  is  divided  into  sections  and  each 
section  is  given  practical  and  individual  work  under  the  supervision 
of  the  instructors. 

This  course  begins  with  the  study  of  the  general  principles  of  opera- 
tive surgery;  anaesthesia,  asepsis,  antisepsis,  description  of  instru- 
ments and  sutures,  etc. 

The  various  operations  are  first  described  and  demonstrated  by  the 
instructor,  and  the  student  afterward  practices  them  upon  the  subject. 

The  entire  subject  of  operative  surgery  is  fully  covered.  Dr.  Mar- 
tin and  assistants. 

The  class  will  be  divided  into  small  sections  for  Dispensary  service 
in  the  University  and  Mercy  Hospitals. 

Fourth  Year.  Fractures  and  Dislocations.  Illustrated  by  charts, 
drawings,  specimens.  X-ray  demonstrations,  lantern  slides,  and  the 
balopticon,  two  hours  a  week  for  the  first  semester.     Dr.  Winslow. 

Surgery  of  the  Blood  Vascular  System,  Hernia,  Surgery  of  the 
Scrotum  and  its  contents,  one  hour  a  week  for  the  first  semester. 
Dr.  Warfield.  At  the  end  of  this  semester,  an  examination  will  be 
given. 

Surgery  of  the  Thorax  and  Thoracic  Wall  and  of  the  Abdominal 
Cavity,  two  hours  a  week  for  the  second  semester.     Dr.  Harrison. 

Surgery  of  the  Head,  Neck,  and  Spinal  Cord,  one  hour  a  week 
for  the  second  semester.     Dr.  Chambers. 

Surgical  C  linics.  Surgical  clinics  will  be  given  at  the  University, 
Mercy,  and  Maryland  General  Hospitals,  weekly,  to  one  third  of 
the  class  in  each  hospital.  Drs.  Winslow,  Warfield,  Chambers,  and 
Harrison. 

The  class  is  divided  into  sections  for  ward  instruction  in  surgery, 
for  instruction  in  operative  surgery  and  surgical  diagnosis,  and  the 
post-operative  treatment  of  surgical  conditions,  six  days  a  week  for 
two  hours  each  day  in  each  of  the  three  hospitals.  Drs.  Winslow, 
Shipley,  Warfield,  Chambers,  Harrison,  Martin  and  McGlannan. 


62  CLINICAL    INSTRUCTION 

ANAESTHESIA. 

S.  Griffith  Davis,  M.D Associate  Professor  of  Anaesthesia 

Frank  S.  Lynn,  M.D Associate  Professor  of  Anaesthesia 

Fred  Rankin,  A.M.,  M.D Associate  in  Anaesthesia 

Samuel  W.  Moore,  D.D.S Instructor  in  Anaesthesia 

A.  M.  Evans,  M.D Instructor  in  Anaesthesia 

The  administration  of  anaesthetics  is  taught  didactially  and  prac- 
tically and  students  are  required  to  administer  anaesthetics  under 
the  direction  of  an  instructor. 

DERMATOLOGY. 

T.  Caspar  Gilchrist,  M.R.C.S.,L.S.A.,M.D Professor  of  Dermatology 

Melvin  Rosenthal,  M.D Associate  Professor  of  Dermatology 

John  R.  Abercrombie,  A.B.,  M.D Associate  Professor  of  Dermatology 

L.  W.  Ketron,  A.B.,  M.D Associate  Professor  of  Dermatology 

Harry  M.  Robinson,  M.D Demonstrator  of  Dermatology 

Clinical  conference  one  hour  each  week  to  entire  class.  This 
course  will  consist  of  demonstrations  of  the  common  diseases  of 
the  skin.     Drs.  Gilchrist  and  Rosenthal. 

Dispensary  instruction,  University  Hospital,  Mondays,  Wednes- 
days and  Fridays  in  the  diagnosis  and  treatment  of  the  common 
skin  diseases.  First  trimester.  Dr.  Ketron;  second  trimester,  Dr. 
Abercrombie;  third  trimester,  Drs.  Abercrombie  and  Ketron.  Dis- 
pensary instruction,  Mercy  Hospital,  Dr.  Rosenthal. 

ORTHOPEDIC  SURGERY. 

R.  TuNSTALL  Taylor,  A.B.,  M.D Professor  of  Orthopedic  Surgery 

Albertus  Cotton,  A.M.,  M.D Professor  of  Orthopedic  Surgery 

CoMPTON  RiELY,  M.D Clinical  Professor  of  Orthopedic  Surgery 

Sydney  M.  Cone,  A.B.,  M.D Clinical  Professor  of  Orthopedic  Surgery 

Henry  J.  Walton,  M.D Associate  in  Roentgenology 

W.  H.  Daniels,  M.D Demonstrator  in  Orthopedic  Surgery 

John  Evans,  M.D Instructor  in  Roentgenology 

C.  Reid  Edwards,  M.D Assistant  in  Orthopedic  Surgery 

Louis  A.  Buie,  A.B.,  M.D Assistant  in  Orthopedic  Surgery 

In  this  course  didactic,  clinical,  bed-side  and  out-patient  instruc- 
tion will  be  given.  This  instruction  is  provided  in  the  University 
Hospital  Amphitheater  and  Dispensary,  Maryland  General  and 
Mercy  Hospitals  and  Dispensaries,  Kernan  Hospital  and  Industrial 


CLINICAL    INSTRUCTION  63 

School  for  Crippled  Children  at  "Radnor  Park,"  and  in  the  Dis- 
pensary of  same  at  2000  North  Charles  Street. 

The  senior  class  will  be  divided  into  three  parts,  each  section  spend- 
ing one  trimester  in  the  University,  Mercy  and  Maryland  General 
Hospitals  in  rotation;  and  by  the  avoidance  of  duplication,  the  sub- 
ject will  be  adequately  covered.  Lectures,  clinics  and  quizzes 
will  be  held  at  each  of  the  three  hospitals  once  a  week.  If  possible, 
in  addition,  a  weekly  bed-side  clinic  will  be  held  on  Saturdays  for 
small  sections  of  the  class  at  "Radnor  Park." 

The  course  will  cover  instruction  in  special  methods  and  instru- 
ments required  in  this  surgical  specialty,  including  X-Ray  technique; 
Wolff's  law;  tuberculosis  of  bones  and  joints;  deformities  of  the 
feet;  non-tuberculous  deformities  of  the  feet  and  joints;  the  paraly- 
ses; the  bursal,  tendinous  and  muscular  conditions  producing  ortho- 
pedic affections;  rickets;  scurvy;  osteomalacia;  chondrodystrophies; 
wry-neck  and  the  use  and  application  of  orthopedic  apparatus. 

DISEASES  OF  THE  THROAT  AND  NOSE. 

Samuel  K.  Merrick,  M.D Professor  of  Diseases  of  the  Throat  and  Nose 

John  R.  Winslow,  A.B.,M.D.,  Professor  of  Diseases  of  the  Throat  and  Nose 

Frank  Dyer  Sanger,  M.D Professor  of  Diseases  of  the  Throat  and  Nose 

George  W.  Mitchell,  M.D. 

Associate  Professor  of  Diseases  of  the  Throat  and  Nose 
H.  C.  Davis,  M.D. .  .Associate  Professor  of  Diseases  of  the  Throat  and  Nose 
George  Murgatroyd,  M.D.... Associate  in  Diseases  of  the  Throat  and  Nose 

William  Caspari,  M.D Associate  in  Diseases  of  the  Throat  and  Nose 

H.  L.  SiNSKEY,  M.D Assistant  in  Diseases  of  the  Throat  and  Nose 

Third  Year.  Clinical  Lectures.  One  hour  each  week  through- 
out the  session.     Drs.  Merrick,  John  R.  Winslow,  and  Sanger. 

Fourth  Year.  Dispensary  instruction  daily  in  small  sections 
at  the  University,  Maryland  General,  and  Mercy  Hospitals.  Ward 
classes  one  hour  each  week  at  the  University,  Maryland  General, 
and  Mercy  Hospitals. 

GENITO-URINARY  DISEASES. 

Gideon  Timberlake,  M.D Professor  of  Genito-Urinary  Diseases 

Page  Edmunds,  M.D Clinical  Professor  of  Genito-Urinary  Diseases 

W.  B.  Wolf,  M.D Associate  Professor  of  Genito-Urinary  Diseases 

A.  J.  Underbill,  A.B.,  M.D.. Associate  Professor  of  Genito-Urinary  Diseases 
Anton  G.  Rytina,  A.B.,  M.D. 

Associate  Professor  in  Genito-Urinary  Diseases 


64  CLINICAL    INSTRUCTION 

The  course,  which  is  entirely  cHnical,  is  taught  chiefly  by  personal 
instruction  in  the  dispensaries  of  the  University,  Mercy  and  Maryland 
General  Hospitals,  one  trimester  being  spent  at  each  hospital. 
The  student  assumes  the  responsibility  of  certain  cases  under  the 
supervision   of  instructors. 

The  course  includes  the  diagnosis,  pathology  and  treatment  of 
venereal  diseases  and  syphilis  together  with  a  careful  study  of  the 
less  common  genito-urinary  diseases.  The  course  includes  instruc- 
tion in  urinalysis,  in  endoscopic  and  cystoscopic  examinations  and 
the  use  of  other  instruments  for  the  diagnosis  and  treatment  of 
genito-urinary  diseases.  Many  minor  operations  are  performed  in 
.the  out-patient  department  by  students  under  the  supervision  of 
the  chiefs  of  clinic. 

DISEASES  OF  THE  COLON  AND  RECTUM. 

G.  Milton  Linthicum,  A.M.,  M.D. 

Professor  of  Diseases  of  Rectum  and  Colon 

Charles  I.  Blake,  M.D Professor  of  Diseases  of  Rectum  and  Colon 

J.  Dawson  Reeder,  M.D. 

Associate  Professor  of  Diseases  of  Rectum  and  Colon 
Ernest  G.  Mark,  M.D Instructor  in  Diseases  of  Rectum  and  Colon 

Fourth  Year.  This  course  is  for  instruction  in  diseases  of  the 
Colon,  Sigmoid  Flexure,  Rectum  and  Anus. 

One  lecture  a  week  throughout  the  year  will  be  given  in  the  Clini- 
cal Amphitheater  of  the  Hospitals.  The  lecture  will  cover  the 
essential  features  of  the  Anatomy  and  Physiology  of  the  large  in- 
testine; as  well  as  the  various  diseases  to  which  it  is  subject.  The 
importance  of  diseased  conditions  and  malpositions  of  the  intestines, 
in  relation  to  systemic  disturbances,  will  be  emphasized  by  demon- 
strations. 

In  small  groups,  the  students  will  be  taken  into  the  wards  and 
dispensaries  of  the  University,  Mercy,  and  Maryland  General  Hos- 
pitals, where  different  phases  of  the  various  diseases  will  be  taught 
by  direct  observation  and  examination.  The  use  of  the  proctoscope 
and  sigmoidoscope  in  examination  of  the  rectum  and  sigmoid  will 
be  made  familiar  to  each  student. 

A  course  in  Proctoscopy  will  be  given  in  th'?>  Cit}'  Hospitals  at 
Bay  View,  where  abundance  of  material  is  always  obtainable. 


CLINICAL    INSTRUCTION 


65 


DEPARTMENT  OF  MEDICINE. 


Charles  W.  Mitchell,  A.M.,  M.D. 

Gordon  Wilson,  M.D. 

Gary  B.  Gamble,  Jr.,  A.M.,  M.D. 

Julius  Friedenwald,  A.M.,  M.D. 

Ernest  Zueblin,  M.D. 

John  S.  Fulton,  A.B.,  M.D. 

Chas.  G.  Hill,  A.M.,  M.D. 

Joseph  E.  Gichner,  M.D. 

Irving  J.  Spear,  M.D. 

Edward  N.  Brush,  M.D. 

John  Ruhr.^h,  M.D. 

Andrew  C.  Gillis,  A.M.,  M.D. 

Edgar  B.  Friedenwald,  M.D. 

Thomas  W.  Keown,  AB.,  M.D. 

Wm.  I.  Messick,  M.D. 

G.  Howard  White,  A.B.,  M.D. 

A.  H.  Carroll,  M.D. 

H.  Boyd  Wylie,  M.D. 

C.  C.  W.  JuDD,  A.B.,  M.D. 

J.  E.  POULTON,  M.D. 

H.  D.  McCarty,  M.D. 
John  E.  O'Neill,  M.D. 
G.  F.  Sargent,  M.D. 
J.  Wesley  Cole,  M.D. 
Frank  W.  Keating,  M.D. 
G.  S.  M.  Kieffer,  M.D. 
J.  F.  Hawkins,  M.D. 

D.  D.  V.  Stuart,  Jr.,  M.D. 

E.  E.  Mayer,  M.D. 
John  S.  Fenby,  M.D. 

E.  Le  Compte  Cook,  M.D. 
Frank  J.  Powers,  M.D. 
Chas.  B.  Wheltle,  M.D. 
J.  W.  V.  Clipt,  M.D. 

L.  M.  C.  Parker,  M.D. 

O.  V.  LiNHARD'l,   M.D. 

F.  E.  Shipley,  M.D. 


John   C.   Hemmeter,    M.D.,    Ph.D., 
Sc.D.,  LL.D. 

William  F.  Lockwood,  M.D. 
SrANDisH  McCleary,  M.D. 
Chas.  E.  Simon,  A.B.,  M.D. 
Jose  L.  Hirsh,  A.B.,  M.D. 
Harry  Adler,  A.B.,  M.D. 

Chas.  O'Donovan,  A.M..,  M.D., 
LL.D. 

J.  M.  Craighill,  M.D. 

Chas.  W.  McElfresh,  M.D. 

Jas.  a.  Nydeger,  A.m.,  M.D.,  Sc.D. 

C.  Hampson  Jones,  M.B.,  CM..  M.D. 

G.  Carroll  Lockard,  M.D. 

Harvey  G.  Beck,  M.D.,  D.Sc. 

Pearce  Kintzing,  M.D. 

E.  B.  Freeman,  B.S.,  M.D. 

J.  Clement  Clark,  M.D. 

Hubert  C.  Knapp,  M.D. 

H.  J.  Maldeis,  JVE.D. 

G.  M.  Settle,  A.B.,  M.D. 

T.  Fred  Lbitz,  M.D. 

Wm.  H.  Smith,  M.D. 

J.  Percy  Wade,  M.D. 

R.  C.  Metzel,  M.D. 

Wilbur  P.  Stubbs,  M.D. 

W.  Milton  Lewis,  M.D. 

J.  Harry  Ullrich,  M.D. 

W.  P.  E.  Wise,  M.D. 

H.  U.  Todd. 

J.  J.  O'Mara,  M.D. 

B.  S.  Hanna,  M.D. 
Benjamin  Pushkin,  M.D. 

C.  W.  Rauschenbach,  M.D. 
J.  E.  Brumback,  M.D. 

J.  G.  Stiefel,  M.D, 


56  CLINICAL    INSTRUCTION 

PHYSICAL  DIAGNOSIS. 

Second  Year.  Didactic  lectures  and  practical  demonstrations 
in  medical  topography  and  the  physical  conditions  in  health,  pre- 
paratory to  the  course  in  physical  diagnosis  in  the  third  year.  Two 
and  one-half  hours  each  week  during  the  second  semester. 

Third  Year.  The  class  is  divided  into  small  groups,  and  each 
section  receives  instruction  for  the  entire  session  in  the  medical 
dispensaries  of  the  hospitals.  During  the  second  semester,  the 
students  under  the  supervision  of  instructors  examine  and  treat 
patients  in  the  medical  dispensaries.  During  one  semester  small 
groups  are  sent  for  the  afternoon  to  the  city  hospitals  at  Ba}^  View 
for  special  instruction  in  history  taking  and  phj'-sical  diagnosis. 
Two  hours  a  week  throughout  the  year  is  devoted  to  physical  diag- 
nosis. Full  class  conferences  one  hour  a  week  throughout  the 
session. 

CLINICAL  PATHOLOGY. 

Third  Year.  A  laboratory  course,  supplemented  by  lectures 
and  recitations  is  given  throughout  the  year  to  the  entire  class. 
Four  hours  a  week  is  devoted  by  each  student  to  laboratory  study 
with  sufficient  instructors  to  insure  careful  work.  Each  student 
is  required  to  rent  at  a  nominal  figure  a  microscope  which  he  is 
permitted  to  use  where  and  when  he  likes,  being  encouraged 
to  use  the  laboratories  at  other  times  than  those  required.  This 
course  is  essentially  practical,  and  the  student  is  thoroughly  trained 
in  the  chemical  and  microscopical  study  of  the  blood,  urine,  spu- 
tum, feces,  and  the  physiological  and  pathological  secretions  and 
excretions. 

Fourth  Year.  Four  hours  a  week  is  devoted  to  advanced  labor- 
atory work  with  small  groups  in  the  special  studies  of  the  blood, 
etc.,  as  required  for  blood  cultures,  Wassermanns,  and  other  diag- 
nostic methods.  In  addition,  each  student  is  required  in  his  course 
in  clinical  medicine  to  do  the  necessary  laboratory  examinations 
of  the  patients  assigned  to  him. 

CLINICAL  MEDICINE. 

Third  Year.  Lectures  and  recitations  on  the  principles  of  medi- 
cine, for  three  hours  a  week  throughout  the  session.  Clinical  con- 
ference, one  hour  each  week  throughout  the  session. 


CLINICAL    INSTRUCTION  Q7 

Fourth  Year.  Lectures,  recitations  and  clinics  to  the  entire 
class  three  hours  a  week  throughout  the  session. 

A  cHnical  pathological  conference  is  held  once  a  week  through- 
out the  session,  at  which  the  material  obtained  through  operations 
or  at  autopsy  is  studied  in  relation  to  the  clinical  findings. 

The  whole  class,  divided  between  the  three  hospitals  and  again 
subdivided  into  small  groups,  receives  bedside  instruction  twelve 
hours  a  week  throughout  the  session  and  has  the  care  of  the  hospital 
patients  under  the  direct  supervision  of  the  hospital  staff,  making 
all  examinations  and  keeping  the  clinical  history  of  the  patient. 

During  one  trimester  the  student  must  live  in  the  hospital  dor- 
mitories, and  in  this  manner  receive  experience  as  an  intern. 

Dispensary  instruction  is  given  nine  hours  a  week  in  the  special- 
ties of  medicine. 

PEDIATRICS. 

Third  Year.  Lecture  recitation  one  hour  a  week  throughout 
the  session. 

Fourth  Year.  Clinic  recitation  one  hour  a  week  throughout 
the  year  and  in  addition  ward  class  instruction  to  small  groups  one 
hour  a  week  during  one  trimester. 

Dispensary  instruction  in  pediatrics  is  given  to  small  groups 
throughout  the  year. 

THERAPEUTICS. 

Physical  Therapeutics.  This  course  consists  of  weekly  lectures 
and  demonstrations  on  hydrotherapy,  thermotherapy,  massage, 
rest  and  exercise,  the  Weir  Mitchell  Treatment,  radiotherapy  and 
electrotherapeutics.  The  basic  physiologic  principles  and  actions 
of  the  above  mentioned  agencies  are  given  full  consideration  and 
study,  and  the  practical  application  is  observed  in  the  hospital  and 
clinic  and  in  visits  to  various  institutions  having  well  equipped 
departments  for  treatment  by  physical  means. 

Third  Year.  This  course  is  supplementary  to  that  on  clini- 
cal medicine  and  an  effort  is  made  to  familiarize  the  student  with 
the  practical  treatment  of  disease.     (One  hour  a  week.) 

Fourth  Year.  This  subject  is  covered  in  conjunction  with  the 
teaching  of  clinical  medicine. 


68  CLINICAL    INSTRUCTION 

GASTRO-ENTEROLOGY. 

Fourth  Year.  Clinic  recitation  to  each  third  of  the  class  for 
one  hour  a.  week  throughout  the  session.  Dispensary  instruction 
to  small  groups  during  part  of  the  session.  Practical  instruction 
in  the  wards  in  the  differential  diagnosis  of  diseased  conditions  of 
the  alimentary  tract. 

TUBERCULOSIS. 

A  practical  course  is  given  in  the  tuberculosis  dispensary  and 
at  the  Municipal  Tuberculosis  Hospital  to  small  groups,  the 
abundance  of  the  material,  both  of  "incipient"  and  "advanced  cases" 
making  this  course  of  value  in  the  practical  recognition  of  the 
physical  signs  of  the  disease. 

NEUROLOGY. 

Third  Year.  Lectures  and  recitations  one  hour  each  week  to 
entire  class  throughout  the  year.  This  course  comprises  the  study 
of  the  anatomy  and  phj^siology  of  the  nervous  system,  the  method 
of  neurological  examination,  and  relationship  of  signs  and  symptoms 
to  pathological  conditions.  The  material  at  the  University,  Mary- 
land General,  and  Mercy  Hospitals  is  available. 

Fourth  Year.  Clinical  lectures  and  recitations;  one  hour  each 
week  throughout  the  entire  session. 

Clinical  Conference,  one  hour  each  week  to  the  entire  class.  This 
subject  is  taught  at  the  University,  Maryland  General,  and  Mercy 
Hospitals.  All  cases  presented  at  these  clinics  are  carefully  ex- 
amined; complete  written  records  are  made  by  the  students  who 
demonstrate  the  cases  before  the  class.  These  cases  are  usually 
assigned  one  or  two  weeks  before  they  are  presented,  and  each 
student  in  the  class  must  prepare  one  or  more  cases  during  the  year. 

Ward  Class  Instruction.  In  small  sections,  two  hours  each  week 
during  entire  year  at  the  University,  Maryland  General,  and  Mercy 
Hospitals.  In  these  classes  the  students  come  in  close  personal 
contact  with  the  cases  in  the  wards  under  the  supervision  of  the 
instructor. 

Dispensary  Instruction.  Small  sections  are  instructed  in  the 
dispensaries  of  the  Universit}^,  Maryland  General,  and  Mercy 
Hospitals  four  afternoons  each  week.     In   this  way  students  are 


CLINICAL    INSTRUCTION  69 

brought  into  contact  with  nervous  diseases  in  their  earlier  as  well 
as  later  manifestations. 

Electro  Therapeutics.  Instruction  in  the  uses  of  the  various 
types  of  electrical  apparatus  is  given  by  lectures  and  demonstra- 
tions in  the  clinics,  the  ward  classes,  and  the  out-patient  depart- 
ment. 

PSYCHIATRY. 

Fourth  Year.  This  subject  is  taught  by  means  of  didactic 
and  clinical  lectures.  Abundant  material  is  at  the  command  of 
this  department  in  the  various  institutions  which  are  presided  over 
by  the  teachers  in  psychiatry.  The  student  is  brought  into  contact 
with  the  early  manifestations  of  mental  disease  in  the  dispensaries 
of  the  University,  Maryland  General,  and  Mercy  Hospitals,  and 
in  a  series  of  clinics  opportunity  is  afforded  to  observe  the  course 
and  later  manifestations  of  the  disease,  often  in  these  same  patients, 
at  the  Sheppard  Enoch  Pratt  Hospital,  Springfield  State  Hospital, 
Spring  Grove  State  Hospital,  Mount  Hope  Retreat,  Maryland  Train- 
ing School  for  the  Feeble  Minded,  and  City  Detention  Hospital. 

STATE  MEDICINE. 

Fourth  Year.  Lectures  and  demonstrations  one  hour  each 
week  to  the  entire  class  throughout  the  session. 

The  course  in  state  medicine  begins  with  a  study  of  structure 
and  function  of  the  social  organism,  as  revealed  by  the  numerical 
analysis  of  population,  births,  deaths,  sickness  and  migration. 
Elementary  instruction  and  practice  are  given  in  vital  statistics; 
in  medical  notification,  registration  and  certification;  and  in  the 
laws  and  ordinances  concerning  public  health.  The  specific  hy- 
giene of  the  preventable  diseases  is  next  taken  up,  such  choice  be- 
ing made  as  will  familiarize  the  student  with  the  epidemiology  of 
the  more  important  communicable  diseases,  and  with  the  main 
instruments  of  prevention:  notification,  inspection,  segregation, 
isolation,  immunization  and  disinfection.  The  course  is  planned 
from  the  view  point  of  official  practice  in  public  hygiene. 

TROPICAL  MEDICINE. 

A  course  of  lectures  on  tropical  diseases  was  instituted  in  Jan- 
uary, 1913,  by  Dr.  James  A.  Nydegger  of  the  U.  S.  P.  H.  Service. 


70  CLINICAL    INSTRUCTION 

One  lecture  is  given  each  week  to  the  members  of  the  Senior  Class, 
frequently  by  Government  officials  who  arc  recognized  authorities 
on  diseases  peculiar  to  the  tropics. 

DEPARTMENT  OF  OBSTETRICS. 

L.  E.  Neale,  A.m.,  M.D.,  LL.D Professor  of  Obstetrics 

Geo.  W.  Dobbin,  M.D Professor  of  Obstetrics  and  Gynecology 

J.  M.  H.  Rowland,  M.D Professor  of  Obstetrics 

Bernard  Purcell  Muse,  M.D Professor  of  Clinical  Obstetrics 

Charles  E.  Brack,  M.D Clinical  Professor  of  Obstetrics 

Glenn  M.  Litsinger,  M.D Associate  Professor  of  Obstetrics 

J.  K.  B.  E.  Seeqar,  M.D Associate  Professor  of  Obstetrics 

H.  S.  Gorsuch,  M.D Associate  in  Obstetrics 

Maurice  Lazenby,  M.D Associate  in  Obstetrics 

Emil  Novak,  M.D Associate  in  Obstetrics 

J.  McF.  Bergland Associate  in  Obstetrics 

H.  N.  Freeman,  M.D Instructor  in  Obstetrics 

M.  E.  Douglass,  M.D Instructor  in  Obstetrics 

Wm.  B.  Schapiro,  M.D Assistant  in  Obstetrics 

Third  Year.  Lectures  and  recitations  two  hours  each  week 
by  Drs.  Neale  and  Dobbin  to  entire  class.  Special  obstetric 
and  gynecologic  pathology  three  hours  each  week  by  Drs.  Brent 
and  Lazenby  to  class  sections  in  the  Pathologic  Laboratory. 
Clinical  Obstetrics  (bedside  and  manikin  work)  three  hours  each 
week  at  the  University  Hospital  by  Dr.  Neale  and  his  assistants, 
and  at  the  Mercy  Hospital  by  Drs.  Brack,  Litsinger,  Lazenby  and 
Novak. 

Examinations,  one  at  end  of  first  semester  and  final  one  at  end 
of  the  year.  The  results  of  these  examinations  considered  in  con- 
junction with  the  student's  practical  work,  will  determine  the 
grade  for  the  year's  work,  which  grades,  if  sufficient  to  give  student 
advanced  standing,  will  count  as  one-half  of  the  final  grade  in 
Obstetrics. 

Fourth  Year.  Lectures  and  Clinical  Conferences.  Two  hours 
each  week  to  the  entire  class.     Drs.  Neale,  Dobbin  and  Rowland. 

Ward  Classes  and  Operative  Obstetrics  (Manikin  work).  Four 
hours  each  week  to  sections  of  the  class. 

Students  are  required  to  attend  obstetric  cases  before,  during 
and  after  confinement  in  the  University  Hospital,  Maryland  Ly- 
ing-in Hospital  and  Maryland  Lying-in  Asylum,  as  well  as  in  the 
out-patient  department  conducted  by  each  hospital.     Each  student 


CLINICAL    INSTRUCTION  71 

is  required  to  conduct  and  make  accurate  records  of  at  least  twelve 
confinement  cases.  These  out-patient  cases  are  conducted  under 
the  supervision  of  post-graduate  instructors,  three  in  number,  who 
devote  their  whole  time  to  this  work. 

Mid-year  and  final  examinations  will  be  held,  the  results  of  which, 
considered  in  conjunction  with  clinical  work  and  recitations,  will 
make  up  the  remaining  half  of  the  final  grade. 

This  School  is  peculiarly  fortunate  in  the  clinical  material  avail- 
able for  this  important  branch  of  medical  teaching;  more  than  2000 
cases  in  the  three  hospitals  and  their  out-patient  departments  make 
a  practically  inexhaustible  clinic. 

DEPARTMENT  OF  GYNECOLOGY. 

William  S.  Gardner,  M.D Professor  of  Gynecology 

W.  B.  Perry,  M.D Professor  of  Clinical  Gynecology 

J.  Mason  Hundley,  M.D Professor  of  Clinical  Gynecology 

Hugh  Brent,  M.D Associate  Professor  of  Gynecology 

Abraham  Samuels,  M.D Associate  Professor  of  Gynecology 

E.  H.  Hayward,  M.D Associate  in  Gynecology 

Geo.  a.  Strauss,  M.D Associate  in  Gynecology 

R.  G.  WiLLSE,  M.D Demonstrator  of  Gynecology 

W.  K.  White,  M.D Instructor  in  Gynecology 

R.  L.  Mitchell,  M.D Instructor  in  Gynecology 

H.  S.  Street,  B.S.,  M.D Instructor  in  Gynecology 

J.  M.  Fenton,  M.D Assistant  in  Gynecology 

Maurice  Lazenby,  A.B.,  M.D Assistant  in  Gynecology 

L.  H.  Douglass,  M.D Assistant  in  Gynecology 

Third  Year.  Didactic  Work.  Lectures  and  rocitations  one  hour 
each  week  throughout  the  session. 

Laboratory.  Special  pathology,  both  gross  and  microscopical, 
studied  in  connection  with  the  clinical  history  of  each  specimen, 
three  hours  each  week  for  one  semester. 

Fourth  Year.  Didactic  Work.  Lectures  and  recitations  one 
hour  each  week  throughout  the  session. 

Clinical  Work.  Six  hours  weekly  for  one  trimester.  In  this 
course  a  student  writes  the  clinical  history  of  each  patient  in  the 
ward,  makes  a  general  physical  examination  including  the  blood 
and  urine,  before  the  patient  is  brought  before  the  class.  One  stu- 
dent under  supervision  gives  the  anesthetic,  a  pelvic  examination 
is  made  by  six  students,  and  any  operation  required  is  then  done 
before  a  section  of  the  class  small  enough  to  see  clearly  what  is 


72  CLINICAL    INSTRUCTION 

being  done  and  how  it  is  done.  On  a  subsequent  day  the  whole 
group  examine  microscopically  sections  prepared  from  material 
removed  from  patients  that  have  been  before  them. 

DEPARTMENT  OF  OPHTHALMOLOGY  AND   OTOLOGY. 

Harry  Friedenwald,  A.B.,  M.D.. .Professor  of  Ophthalmology  and  Otology 

Hiram  Woods,  A.M.,  M.D Professor  of  Ophthalmology  and  Otology 

J.  Frank  Crouch,  M.D Professor  of  Clinical  Ophthalmology  and  Otology 

Wm.  Tarun,  M.D Clinical  Professor  of  Ophthalmology  and  Otology 

H.  E.  Peterman,  M.D Associate  in  Ophthalmology  and  Otology 

Clyde  A.  Clapp,  M.D Associate  in  Ophthalmology  and  Otology 

H.  K.  Fleckenstein,  M.D Associate  in  Ophthalmology  and  Otology 

Joseph  1.  Kemler,  M.D Associate  in  Ophthalmology  and  Otology 

J.  W.  Downey,  M.D Associate  in  Otology 

G.  A.  Fleming,  M.D Demonstrator  of  Ophthalmology  and  Otology 

Edwarp  a.  Looper,  M.D.,  D.Oph.. Instructor  in  Ophthalmology  and  Otology 
R.  D.  West,  M.D Assistant  in  Ophthalmology  and  Otology 

Third  Year.  Practical  Course  in  the  anatomy,  gross  and  micro- 
scopic, and  in  the  physiology  of  the  eye  and  the  ear;  this  course  con- 
sists of  dissections,  microscopic  sections,  demonstration  on  models, 
etc.,  once  weekly  throughout  one  half  the  year. — Dr.  Tarun. 

Practical  Course  in  the  Methods  of  Examination  of  the  eye,  includ- 
ing the  use  of  the  ophthalmoscope,  and  of  the  ear,  including  the 
tests  of  the  auditory  apparatus. — Drs.  Fleckenstein  and  Downey. 

Fourth  Year.  Didactic  Course  in  Diseases  of  the  Eye  once 
weekly  October  to  February,  Dr.  Woods;  Februarj^  to  close  of 
session.   Dr.   Harry  Friedenwald. 

Didactic  Course  in  Diseases  of  the  Ear,  Dr.  Crouch  once  weakly 
for  half  the  year. 

Clinics  in  diseases  of  the  eye  and  ear  to  sections  of  the  class  once 
weekl}?^,  by  Drs.  Harry  Friedenwald,  Woods  and  Crouch. 

Dispensary  Instruction  to  small  sections. 

The  courses  in  Ophthalmology  and  Otology  are  designed  to 
familiarize  the  students  with  the  common  diseases  of  the  eye  and 
ear,  their  recognition  and  treatment,  with  a  view  to  meet  the  needs 
of  the  general  practitioner.  Special  emphasis  is  laid  upon  the  re- 
lation between  diseases  of  the  eye  and  the  ear  and  systemic  diseases 
of  other  organs. 


TRAINING    SCHOOL    FOR    NURSES  73 

THE  UNIVERSITY  HOSPITAL  TRAINING   SCHOOL   FOR  NURSES. 

Mary  E.  Sullivan,  R.N.,  M.U.H.  1911,  Superintendant  oj  Training  Schools. 

The  University  Hospital  Training  School  for  Nurses  was  organized 
December  14,  1889,  and  offers  a  three  years'  course  of  training. 

Those  wishing  to  obtain  the  course  of  instruction  must  apply 
personally  or  by  letter  to  the  Superintendent  of  Nurses,  who  will 
furnish  printed  instructions  respecting  the  personal  information 
to  be  given  by  applicants.  Letters  of  application  should  be  accom- 
panied by  a  statement  from  a  clergyman  testifying  to  good  moral 
character  and  from  a  physician  certifying  to  sound  health  and 
unimpaired  faculties.  Applicants  must  be  between  twenty-one 
and  thirty-five  years  of  age,  of  at  least  average  height  and  physique, 
and  must  give  satisfactory  evidence  of  fitness  in  disposition  and 
temperament  for  the  work  of  nursing. 

If  approved,  applicants  are  received  into  the  school  for  a  period 
of  six  months  on  probation,  during  which  time  demonstration  classes 
are  held,  and  instruction  is  given  in  the  elementary  part  of  the 
training. 

Classes  are  formed  and  pupils  are  received  in  the  spring  and 
autumn. 

High  school  graduates  and  women  of  higher  education  are  given 
the  preference.  Their  superior  preparation  makes  them  better 
fitted  for  the  opportunities  that  are  opening  up  in  the  profession 
of  nursing.  Graduates  of  this  school  are  eligible  for  Red  Cross 
and  all  Government  work. 

The  Superintendent  of  Nurses  decides  as  to  the  fitness  of  proba- 
tioners for  the  work,  and  the  propriety  of  retaining  or  dismissing 
them,  and  she  may  at  any  time  terminate  the  connection  of  a  pupil 
with  the  school  in  case  of  misconduct,  inefficiency  or  neglect  of 
duty. 

Except  under  special  circumstances  failure  to  pass  the  examina- 
tions at  the  end  of  the  first  year  is  considered  a  sufficient  cause  for 
the  termination  of  a  student's  connection  with  the  school. 

Students  reside  in  the  home  and  serve  as  assistants  in  the  various 
departments  of  the  Hospital  for  the  full  three  years.  They  are  ex- 
pected to  perform  any  duty  assigned  to  them  by  the  Superintendent 
of  Nurses. 

After  the  period  of  probation,  students  are  required,  when  on 
duty,  to  wear  the  dress  prescribed  by  the  Hospital,  which  is  blue 


74  TRAINING    SCHOOL    FOR    NURSES 

and  white  striped  gingham,  with  white  apron  and  cap  and  hnen 
collar  and  cuffs.     Probationers  are  not  allowed  to  wear  this  dress. 

To  the  University  Hospital  belongs  the  honor  of  bestowing  upon 
its  graduates  a  cap  that  possesses  a  real  history — the  Florence  Night- 
ingale cap,  installed  by  Miss  Parsons,  a  graduate  of  St.  Thomas 
Hospital,  London,  and  the  first  superintendent  of  the  University 
Hospital  Training  School  for  Nurses. 

Day  Nurses  are  on  duty  from  7  a.m.  to  7  p.m.  with  one  hour 
for  dinner,  and  three  hours  for  rest  and  recreation.  They  are  given 
an  afternoon  each  week  and  part  of  every  Sunday.  Each  student 
is  required  to  devote  at  least  one  hour  daily  to  lecture,  class  work 
or  study.     A  vacation  of  three  weeks  is  allowed  each  year. 

In  sickness  all  students  are  cared  for  gratuitously,  but  the  time 
so  lost  must  be  made  up. 

The  course  of  training  includes  practical  instruction  in  the  nurs- 
ing of  medical,  surgical,  orthopedic,  gynecological  patients,  ob- 
stetrics, the  nursing  of  children,  and  the  operating  room  work. 

A  course  of  lectures  is  given  by  the  physicians  and  surgeons  of 
the  University,  and  class  instruction  with  demonstrations  by  the 
Superintendent  of  Nurses  and  her  assistants.  Examinations  are 
held  at  stated  periods. 

When  the  full  term  of  three  years  is  ended,  the  nurses  thus  trained 
will  be  at  liberty  to  choose  their  own  fields  of  labor,  whether  in 
hospitals,  in  private  families,  or  in  the  various  branches  of  social 
work  which  offer  opportunities  for  the  woman  of  ability.  A  diploma 
is  given  upon  completion  of  course  of  training. 

In  addition  to  board,  lodging  and  a  reasonable  amount  of  laundry 
work,  each  student  receives  an  allowance  of  S5.00  per  month  to 
defray  the  expenses  of  uniforms,  text-books,  etc.,  incidental  to  her 
training. 

Graduates,  1916 

Margaret  Dunn .Maryland 

Julia  Irene  Kauffman Maryland 

Marion  Asbury  Forney North  Carolina 

Marguerite  Mary  Walter Maryland 

Sallie  Smith North  Carolina 

Laura  Polly  Clark North  Carolina 

Inez  May  Scarff Maryland 

Anna  Spiller  Hurst Virginia 

EuM A  Blanche  Hoffm aster Maryland 

Lillie  Grace  Null Maryland 

Helen  Bertiell  McSherry Maryland 

Sbrena  Webster  Selfe Maryland 

Margaret  Colin  Mayo Maryland 

Bernice  Violet  Smith Maryland 


TRAINING    SCHOOL   FOR   NURSES  75 

ElAie  Love  Rutherford Virginia 

Helen  I>ambib  Blake Manjland 

HiLDECARDE  Reamy Virginia 

Marie  Estell  Langenfeldt Maryland 

Nellie  Eureka  Dix Virginia 

Elizabeth  Helev  Phelan Canada 

Mary  Edna  Johx Virginia 

Julia  Louise  Henkel Virginia 

Lucy  DuLaney  Scaggs Maryland 

LuLA  Kathryn  Eichner Maryland 

Maud  Warino  Simmons , South  Carolina 

THE  MERCY  HOSPITAL  TRAINING  SCHOOL  FOR  NURSES. 

The  Mercy  Hospital  Training  School  for  Nurses,  conducted  by  the 
Sisters  of  Mercy  and  connected  with  the  College  of  Physicians  and 
Surgeons,  was  organized  and  incorporated  under  the  general  laws 
of  the  State  of  Maryland  in  1899.  Its  first  students  were  graduated 
in  1901;  and  on  the  passage  of  the  bill  for  registration  in  1904,  the 
Sisters  of  Mercy,  connected  with  the  Hospital  service,  received 
certificates  as  registered  nurses. 

The  Training  School  was  affiliated  with  the  Board  of  Regents  of 
the  State  of  New  York  in  1906;  and,  in  the  same  year,  the  Alumnae 
Association  was  incorporated,  having  been  previously  connected 
with  the  Associated  Alumnae  of  the  United  States.  The  graduates, 
as  active  members,  have  been  much  interested  in  the  movements 
of  the  Maryland  Association  of  Graduate  Nurses,  to  whom  they  have 
given  every  encouragement  to  uplift  the  profession  in  its  many 
works  of  district  nursing,  tuberculosis  campaign,  Red  Cross  move- 
ments, etc. 

The  requirements  for  entrance  are:  highest  moral  standing, 
intelligence,  good  education  and  health.  The  age  limit  is  twenty 
to  thirty-five  years. 

After  a  three  months'  probation,  candidates,  if  they  possess  the 
necessary  qualifications,  are  admitted  to  the  Training  School  proper, 
receiving  five  dollars  a  month  wherewith  to  secure  uniforms,  text 
books,  etc.,  the  education  they  receive  being  considered  their  com- 
pensation. The  right  is  reserved  to  dismiss  pupils  for  any  cause 
which  may  be  deemed  sufficient  by  the  Sister  Superior  or  Superin- 
tendent. 

The  course  of  training  comprises  three  years  of  theory  and  prac- 
tice. The  clinical  advantages  are  exceptional.  The  medical, 
surgical,  orthopedic,  gynecological,  obstetrical,  children's  and 
dietetic  departments  give  valuable  practical  experience.     The  nurses 


76  TRAINING    SCHOOL   FOR   NURSES 

are  taught  the  theory  of  nursing  by  class  recitations  and  demon- 
strations by  efficient  Sister  instructors.  Supplementing  this  train- 
ing is  a  course  of  lectures  from  the  ablest  professors  of  the  Univer- 
sity of  Maryland  School  of  Medicine  and  College  of  Physicians  and 
Surgeons,  who  are  untiring  in  their  efforts  to  keep  the  School  abreast 
with  modern  scientific  developments. 

GUADUATES,    1916 

Sister  Maby  Laxtrentine  Harrington Pennsylvania 

EsTELLE  Marie  Baine West  Virginia 

May  Dolores  Bezold Manila  nd 

Genevieve  Makie  Biesecker Maryland 

Teresa  Aileen  Dodgher Pennsyhania 

Rose  Meehan  Fields Maryland 

Marjorie  Hendricks  Gillilan Maryland 

Sarah  Agnes  Gorman Delaware 

Carrie  Belle  Kellican Virginia 

Margaret  Geraldine  McDonough Pennsylvania 

Marjorie  Mary  O'Mailet '. Maryland 

Mary  Elizabeth  Sappington Maryland 

Hazle  Lee  Schweizer Alabama 

Rose  Effie  Selby Maryland 

Grace  Eleanor  Shepperson Pennsylvania 

Carrie  Elizaheth  Shoff Pennsylvania 

Weda  Jane  Shoff Pennsylvania 

Lucy  Seymour  Spicer Maryland 

Carrie  Agnes  Wagman Pennsylvania 

Bertie  Agnes  Weber Maryland 

MARYLAND   GENERAL   HOSPITAL   TRAINING   SCHOOL  FOR  NURSES. 
Alice  E.  Wheeler,  R.N.,  Superintendent  of  Training  School. 

The  Maryland  General  Hospital  Training  School  for  Nurses 
has  been  in  successful  operation  since  1891. 

In  1909  the  Training  School  was  registered  with  the  Board  of 
Regents  of  the  State  of  New  York. 

Its  purpose  is  to  give  to  young  women  desiring  to  understand  the 
science  and  acquire  the  art  of  nursing  the  sick  and  injured,  the 
opportunity,  through  instruction  and  training,  to  qualify  themselves 
for  efficient  and  skillful  work  in  their  humane  and  useful  mission. 

A  candidate  for  admission  must  be  between  19  and  35  years 
of  age. 

She  must  have  a  High  School  education  or  pass  an  examination 
in  the  subjects  embraced  in,  or  equivalent  to,  the  first  two  years' 
curriculum  of  the  High  Schools  of  the  State  of  Maryland. 

She  must  present  a  certificate  from  her  family  physician  testi- 
fying as  to  good  health  and  proper  physical  condition,  and  certifi- 
cates from  two  other  responsible  persons. 


ENDOWMENT   FU-ND  77 

The  first  six  months  will  constitute  a  period  of  probation,  in  which 
the  candidate  must  show  her  fitness  before  she  will  be  finally  ac- 
cepted as  a  pupil.  The  school  reserves  the  right  of  suspension  or 
dismissal  at  any  time,  for  inefficiency,  misconduct,  or  infraction 
of  the  rules  of  discipline. 

A  vacation  of  two  weeks  each  year  is  granted. 

Pupils  are  cared  for  without  expense  in  case  of  illness,  provided 
they  remain  in  the  hospital  and  are  attended  by  members  of  the 
Medical  Staff. 

The  full  course  of  instruction  will  extend  over  a  period  of  three 
calendar  years.  During  the  probationary  period  practical  demon- 
strations are  given  in  the  class  room,  four  hours  each  week.  Nurses 
in  training  receive  instruction  in  the  nursing  of  medical,  surgical, 
orthopedic,  gynecological  patients,  in  operating  room  work,  and 
also  in  obstetrics  and  the  nursing  of  children;  in  addition  to  which, 
courses  of  lectures  are  given  by  the  visiting  physicians  and  sur- 
geons of  the  Maryland  General  Hospital. 

All  examinations  must  be  successfully  passed  before  the  pupil 
will  be  advanced  to  the  work  of  the  following  year. 

Graduate?,  1016 

Daisy  Buownino  Smith Maryland 

Salije  Mae  Callowat Delaware 

Ruth  Calloway Delaware 

Amelia  Loijisb  Giese Maryland 

Nellie  Conway  Gault Maryland 

CoR\.  Elizabeth  Corrigan Pennsylvania 

Minnie  Saphirc  Cheezum Maryland 

Alice  Gertrude  Price Maryland 

Lillian  May  Barrett Maryland 

Mary  Ellen  Kerns '. Maryland 

Elizabeth  Bishop  Phillips Maryland 

Violet  Cassandra  Botbler Maryland 

Blanche  Alexin  a  Morgan Maryland 

Jane  Elizabeth  Sims Virginia 

ENDOWMENT  FUND. 

The  following,  all  Alumni  of  the  University,  constitute  the  Board 
of  Trustees  of  this  Fund:  • 

Hon.  Henky  Stockbridge,  LL.D.  John  B.  Thomas,  Ph.  G. 

Harry  Adler,  M.D.  B.  Merrill  Hopkinson,  M.D. 

Charles  Markell,  LL.B.  Henry  P.  Hynson,  Phar.D. 

This  Board  is  incorporated  by  act  of  the  Legislature  of  the  State, 
its  legal  title  being  "The  Trustees  of  the  Endowment  Fund  of  the 


78  ENDOWMENT   FUND 

University  of  Maryland,"  and  is  independent  and  self-perpetuat- 
ing, filling  itself  any  vacancies.  Its  powers  are  limited  to  the  ex- 
penditure of  the  interest  derived  from  the  fund,  which  is  to  be  applied 
in  the  discretion  of  the  Board  for  the  benefit  of  the  University. 
Contributions,  donations  and  bequests  are  solicited  from  Alumni 
and  friends.  They  may  be  made  to  the  general  or  University 
Fund,  to  the  Medical  Fund  or  to  any  other  department  of  the  Uni- 
versity. If  intended  for  the  School  of  Medicine,  they  may  be 
given  to  the  general  medical  fund  or  to  some  special  object,  as  build- 
ing, research,  library,  pathology,  hospital,  pubhcation, laboratories, 
gymnasium,  scholarship,  medal,  prize,  etc.,  in  which  case  the  wishes 
of  the  donor  will  be  strictly  regarded.  Attention  is  invited  to  the 
"Charles  Frick  Research  Fund,"  already  established  in  memory 
of  that  distinguished  investigator.  Cheeks  should  l)e  made  pay- 
able to  Charles  Markell,  Treasurer,  1137  Calvert  Building,  Bal- 
timore, Md. 

FORMS   OF  DEVISE  OR  BEQUEST. 
To   School  of  Medicine. 

I  give,  devise  and  bequeath  to  the  Regents  of  the  Universitj^  of  Maryland, 
a  corporation  incorporated  under  the  laws  of  the  State  of  Maryland,  for  the 
benefit  of  the  Faculty  of  Physic. , 

(Here  state  amount  or  describe  property.) 

To  Endowment  Fund. 

I  give,  devise  and  bequeath  to  the  Trustees  of  the  Endowment  Fund  of  the 
University  of  Maryland,  a  corporation  incorporated  under  the  laws  of  the 
State  of  Maryland,  for  the  benefit  of  the  Faculty  of  Physic 

(Here  state  amount  or  describe  property.) 


ALUMNI  ASSOCIATIONS. 

UNIVERSITY  OF  MARYLAND  MEDICAL  DEPARTMENT. 

All  alumni  in  good  standing  are  eligible  to  membership. 

The  membership  fee  is  $1.00  per  annum,  payable  in  March. 

The  annual  meetings  are  held  on  or  about  Commencement  Day,  and  an 
orator  will  be  selected  to  deliver  an  address  upon  these  occasions. 

The  Banquet,  which  follows  the  delivery  of  the  oration,  is  a  reunion  of  old 
classmates,  to  which  members  who  have  paid  their  dues  in  full  and  candidates 
who  have  paid  their  initiation  fee  are  admitted  without  extra  charge. 

The  following  are  the  officers  for  the  current  year: 

President 
Dr.  N.  R.  Goeter 

Vice-Presidents 
Dr.  C.  R.  Foutz,  Westminster,  Md. 
Dr.  H.  D.  Fry,  Washington,  D.  C. 
Dr.  Josiah  Bowen,  Mt.  Washington,  Md. 

Recording  Secretary 
Dr.  M.  L.  Lichtenberg 

Assistant  Recording  Secretary 
Dr.  C.  W.  Heffinger,  Sykesville,  Md. 

Treasurer 
Dr.  Edw.  a.  Looper 

Correspojiding  Secretary 
Dr.  J.  I.  Pennington 

Necrologist 
Dr.  Jos.  T.  Smith 

Executive  Committee 
Dr.  Albert  H.  Carroll,  Chairman 
Dr.  B.  Merrill  Hopkins        Dr.  John  Houff 
Dr.  C.  R.  Winterson  Dr.  H.  M.  Jones 


79 


80  ALUMNI   ASSOCIATIONS 

COLLEGE  OF  PHYSICIANS  AND  SURGEONS. 

President 
C.  W.  VOGEL,  M.D. 

1st  yice-President 
Humphry  D.  Wolfe,  M.D. 

2nd  Vice-President 
W  C   Stifler,  M.D. 

Secretary 
H.  C.  Knapp,  M.D. 

Treasurer 
C.  E.  Brack,  M.D. 

Executive  Committee 
Alexius  McGlannan,  M.D. 
H.  K.  Fleckenstein,  M.D.  A.  C.  Gillis,  M.D. 

THE  GENERAL  ALUMNI  ASSOCIATION  OF   THE  UNIVERSITY 
OF  MARYLAND. 

President 
E.  John  W.  Revell,  130S  Fidelity  Building 

'Vice-President 
Albert  H.  Carroll,  The  Walbert  Apartment 

Treasurer 
Wm.  K.  Stichel,  Baltimore  and  Light  Streets 

Recording  Secretary 
Frank  W.  Rhodes,  219  St.  Paul  Street 

Advisory  Council 
Medical 
Dr.  Chas.  A.  Sadler,  1415  Linden  Avenue 
Dr.  Arthur  M.  Shipley,  1827  Eutaw  Place 
Dr.  J.  M.  H.  Rowland,  1204  Madison  Avenue 

Legal 
Mr.  James  W.  Bowers,  16  E.  Lexington  Street 
Mr.  Frank  V.  Rhodes,  219  St.  Paul  Street 
Mr.  J.  H.  Skeen,  920  Equitable  Building 

Denial 

Dr.  H.  F.  Gorgas,  Charles  and  Centre  Streets 
Dr.  Merrill  Hopkinson,  Professional  Building 
Dr.  L.  Wilson  Davis,  331  N.  Charles  Street 


YOUNG   MEN  S    CHRISTIAN   ASSOCIATION  81 

PhartnaccuHcal 
Dr.  John  B.  Thomas,  Baltimore  and  Light  Streets 
Dr.  John  F.  Hancock,  4  S.  Howard  Street 
Dr.  Eugene  W.  Hodson,  Baltimore  and  Light  Streets 

Academic 

Hon.  Walter  L  Dawkins,  1119  Fidelity  Building 
Dr.  James  A.  Nydeger,  University  Club 
J.  W.  Iglehart,  Esq. 

YOUNG  MEN'S  CHRISTIAN  ASSOCIATION  OF  THE 
UNIVERSITY  OF  MARYLAND. 

This  Association  since  its  establishment,  eighteen  years  ago,  has  steadily 
grown  in  numbers  and  influence  and  has  met  a  need  of  College  life. 

All  students  of  any  Department  of  the  University  are  eligible  to  membership 
as  actives  or  associates,  which  membership  includes  special  privileges  in  the 
City  Association. 

Bible  and  Mission  Classes  are  maintained  by  the  Association  throughout 
the  College  year,  and  every  effort  is  exerted  to  promote  Christian  character 
and  morality. 

A  committee  of  members  will  be  on  hand  at  the  opening  of  the  session  in 
Davidge  Hall  to  welcome  new  students  to  the  University,  and  will  also  be 
glad  to  render  assistance  in  the  way  of  securing  comfortable  rooms,  boarding 
houses,  etc.,  and  to  extend  any  other  courtesies  possible. 

All  young  men  who  intend  to  enter  the  University  are  cordially  invited 
to  share  in  the  privileges  of  the  Association,  and,  upon  arriving  in  the  city,  to 
address  the  officers  named  below,  who  will  be  glad  to  furnish  any  information 
desired  regarding  the  Association  and  its  work,  and  to  render  any  assistance 
n  their  power. 

John  W.  Edel  (Law  Department),  President 

M.  L.  Lumpkin  (Medical  Department),  Vice-President 


UNIVERSITY    OF  MARYLAND. 

DEPARTMENT   OF  ARTS  AND   SCIENCES. 

St.  John's   College,   Annapolis,   Md. 
THE  FACULTY. 

Thomas  Fell,  M.A.,  Ph.D.,  LL.D.,  D.C.L.,  President,  Professor  of  Moral  Science. 

John  Brockway  Rippere  M.A.,  Vice-President  (Graduate  of  Wesleyan  University),  Professor 
of  Latin. 

John  B.  White,  M.A.  (Graduate  of  Geneva  College),  Professor  of  Greek  and  Latin. 

Benjamin  Harrison  W.^ddell,  M.A.  (Graduate  of  Washington  and  Lee  University),  Professor 
Mathematics. 

Adolf  Schumacher,  Ph.D.,  (Graduate  of  Gottingen  University,  and  University  of  Pennsylvania) 
Professor  of  French  and  German. 

Reginald  H.  Ridgely,  B.S.,  M.A.  (Graduate  of  St.  John's  College),  Professor  of  Biology. 

John  Clifford  Gray,  B.A.,  M.A.  (Graduate  of  Harvard  University),  Professor  of  Chemistry. 

Chauncey  St.C.  McNeill,  U.  S.  A.,  M.A.,  Lieutenant  of  the  United  States  Army,  Professor  of 
Military  Science  and  Tactics  and  Lecturer  on  International  and  Constitutional  Law. 

Henry  Francis  SxuKnY,  B.A.,  M.A.,  (Graduate  of  St.  John's  College,  and  Johns  Hopkins  Univer- 
sity), Professor  of  History  and  Political  Economy. 

Sidney  S.  Handy,  B.A.,  M.A.  (Graduate  of  Columbia  University),  Professor  of  English. 

Harold  Brenton  Scarborough,  B.A.,  M.A.  (Graduate  of  St.  John's  College),  Professor  of  Draw- 
ing and  Physics. 

Thomas  L.  Gladden,  Instructor  in  Latin  and  Mathematics. 

Roscoe  E.  Grove,  B.A.  (Graduate  of  St.  John's  College),  Instructor  in  German  and  English. 

Sarah  Berry,  Registrar  and  Secretary  for  the  President. 


DEPARTMENT  OF  DENTISTRY. 

The  Regular  Winter  Season  begins  on  October  1  of  each  year,  and  continues  until  the  follow- 
ing May. 

The  requirements  for  admission  are  the  same  as  in  u)l  other  reputable  dental  colleges. 

FACULTY. 

J.  Holmes  Smith,  A.M.,  M.D.,  Professor  of  Anatomy. 

John  C.  Hemmeter,  M.D  ,  Ph.D.,  LL.D.,  Professor  of  Physiology. 

Ti.MOTHY  O.  Heatwole,  M.D  ,  D.D.S.,  Professor  of  Dental  Materia  Medica  and  Therapeutics,  and 

Dean  of  Faculty. 
Is.\AC  H.  Davis,  M.D.,  D.D.S.,  Profes.sor  of  Operative  and  Clinical  Dentistry. 
J.  William  Smith,  D.D.S.,  Professor  of  Dental  Prosthesis. 

Elmer  E.  Cruzen,  D.D.S.,  Professor  of  Crown  and  Bridge  Work  antl  Ceramics. 
E.  Frank  Kelly,  Phar.  D.,  Professor  of  Chemistry  and  Metallurgy. 

B.  Merrill  Hopkinson,  A.M.,  M.D.,  D.D.S.,  Profe.ssor  of  Oral  Hygiene  and  Dental  History. 
Eldridge  Baskin,  M.D.,  D.D.S.,  Professor  of  Orthodontia  and  Associate  Professor  of  Clinical 

Dentistry. 
Clyde  V.  Matthews,  D.D.S.,  Professor  of  Histology. 
J.  W.  Holland,  M.D.,  Associate  Professor  of  Anatomy. 

L.  Writing  F.\rinholt,  D.D.S.,  Demonstrator  of  Crown-Bridge,  Porcelain  and  Inlay  Work. 
Robert  P.  Bay,  M.D.,  Instructor  in  Oral  Surgery. 
Robert  L.  Mitchell,  M.D.,  Instructor  of  Bacteriology  and  Pathology. 
Frank  P.  Hay'Nes,  D.D.S.,  Lecturer  in  Dental  Anatomy 
William  A.  Rea,  D.D.S.,  Chief  Demonstrator  of  Operative  Dentistry. 
Alex.  H.  Paterson,  D.D.S.,  Demonstrator  of  Prosthetic  Dentistry. 
S.  Whiteford  Moore,  D.D.S.,  Demonstrator  of  Anaesthesia  and  Analgesia 
J.  Ben  Robinson,  D.D.S.,  Demonstrator  of  Operative  Dentistry. 
Francis  J.  Valentine,  A.M.,  D.D.S.,  E.  Fitzroy  Phillips,  D.D.S.,  Assistant  Deutai    Demon 

strators. 

82 


UNIVERSITY  OF  MARYI.AND  '      83 

DEPARTMENT  OF  LAW. 

FORTY-SEVENTH  ANNUAL  SESSION. 

THE  BOARD  OF  INSTRUCTION. 

Hon.  Henry  D.  Harlan,  Dean. 

Alfred  Bagbt,  Jr.,  Esq.,  Testamentary  Law. 

Randolph  Barton,  Jr.,  Esq.,  Commercial  Law. 

J.  Wallace  Bryan,  Esq.,  Common  Carriers. 

Howard  Bryant,  Esq.,  Practice  in  State  Courts. 

W.  Calvin  Chesnut,  Esq.,  Insurance. 

Ward  B.  Cob,  Esq.,  Title  and  Conveyancing. 

William  C.  Coleman,  Esq.,  Bills  and  Notes. 

James  U.  Dennis,  Esq.,  Personal  Property,  Including  Bailments. 

Edwin  T.  Dickerson,  Esq.,  Contracts. 

Joseph  C.  France,  Esq.,  Corporations. 

Eli  Frank,  Esq.,  Torts. 

Hon.  Ja.mes  P.  Gorter,  Evidence  and  Pleading. 

Hon.  Henry  D.  Harlan,  Domestic  Relations. 

Charles  McH.  Howard,  Esq.,  Equity  Jurisprudence. 

Arthur  L.  Jackson,  Esq.,  Conflict  of  Laws  and  Internationa!  Law. 

Sylvan  H.  Lauchheimer,  Esq.,  Bankruptc.y  and  Banking  Law. 

Hon.  Alfred  S.  Niles,  Constitutional  Law. 

Eugene  O'Dunne,  Esq.,  Criminal  Law  and  Medical  Jurisprudence. 

William  Lee  Rawls,  Esq.,  Corporations. 

Albert  C.  Ritchie,  Esq.,  Elementary  Law. 

Hon.  John  C.  Rose,  Jurisdiction  and  Procedure  of  the  Federal  Courts,  Admiralty,  Shipping  Patents, 

Trade-Marks  and  Copyrights. 
G.  Ridgley  Sappington,  Esq.,  Practice  Court. 
Herbert  T.  Tiffany,  Esq.,  Real  Property. 
Clarence  A.  Tucker,  Esq.,  Equity  Procedure. 
Joseph  N.  Ullman,  Esq.,  Sales  of  Personal  Property. 

For  catalogue  containing  full  information,  address,  EDWIN  T.   DICKERSON,   Secretary  and 
Treasurer  of  Law  Faculty,  102-5  Law  Building,  Baltimore,  Md. 


DEPARTMENT  OF  PHARMACY. 

MARYLAND   COLLEGE   OF  PHARMACY,   1841-1904. 
the  seventy^hird  annual  session. 

FACULTY 

William  Simon,  Ph.D.,  Emeritus  Professor  of  Chemistry. 

Charles  Caspari,  Jr.,  Phar.D.,  Professor  of  Theoretical  and  Applied  Pharmacy,  Dean  of  tlie 
Faculty. 

David  M.  R.  Culbreth,  A.M.,  Ph.G.,  M.D.,  Professor  of  Materia  Medica,  Botany  and  Pharmacog- 
nosy. 

Daniel  Base,  Ph.D.,  Professor  of  Chemistry  and  Vegetable  Histology. 

Henry  P.  Hynson,  Phar.D.,  Professor  of  Dispensing  and  Commercial  Pharmacy. 

E.  Frank  Kelly,  Phar.D.,  Associate  Professor  of  Pharmacy. 

Charles  C.  Plitt,  Ph.G.,  Associate  Professor  of  Materia  Medica,  Botany  and  Vegetable  Histology. 

J.  Carlton  Wolf,  Phar.D.,  Associate  Professor  of  Dispensing  and  Commercial  Pharmacy. 

Louis  J.  Burger,  Ph.G.,  LL.B.,  Le:turer  on  Pharmaceutical  Jurisprudence. 

George  A.  Stall,  Phar.D.,  Demonstrator  in  Dispensing. 

For  catalogue  and  information,  address,  CHAS.  CASPARI,  Jr.,  Dean. 


INDEX 


Alumni  Associations: 

College  of  Physicians  and  Surgeons 80 

University  of  Maryland 80 

University  of  Maryland  Medical  Depart- 
ment    79 

Annual  Appointments 45 

Board  of  Instruction 6 

Board  of  Regents • 4 

Calendar 2 

Consolidation  of  Schools 33 

Curriculum 63 

Dispensary  Staffs: 

Maryland  General  Hospital 24 

Mercy  Hospital 23 

University  Hospital 22 

Expenses,  Students' 52 

Faculty  of  Physio 5 

Fees 51 

Graduates 31 

Hospitals: 

Franklin  Square  Hospital 37 

James  Lawrence  Kernan  Hospital 39 

Maryland  General  Hospital 36 

Maryland  Lying-in  Asylum,  The  (Mater- 
nity)   37 

Maryland  Lying-in  Hospital,  The 37 

Maternity  Hospital  of  the  University  of 

Maryland 37 

Mercy  Hospital 35 

Mount  Hope  Retreat  for  the  Insane 39 

Municipal  Hospital 38 

Presbyterian  Ear,  Eye  and  Throat  Charity 

Hospital,  The 38 

Rosewood  State  Training  School 40 

Sheppard  and  Enoch  Pratt  Hospital  for 

the  Insane,  The 39 

South    Baltimore    Eye,    Ear,    Nose  and 

Throat  Charity  Hospital 38 

Springfield  State  Hospital 40 

Spring  Grove  State  Hospital 39 


St.  Vincent's  Infant  Asylum 39 

University  Hospital 34 

Laboratories: 

Anatomical 42 

Chemical 42 

Clinical  Pathology 43 

Histology  and  Embryology 43 

Pathology  and  Bacteriology 43 

Physiology 42 

Physiological  Chemistry 42 

Libraries 44 

Matriculates 26 

Museum 44 

Prizes 46 

Publications 45 

Requirements  for  Matriculation 46 

Rules 60 

Scholarships 61 

Staffs: 

City  Hospital  at  Bay  view 19 

James  Lawrence  Kernan  Hospital 18 

Maryland  General  Hospital 16 

Maryland  Lying-in  Asylum  (Maternity)..  21 

Maryland  Lying-in  Hospital,  The 21 

Mercy  Hospital 12 

Nursery  and  Child's  Hospital 20 

St.  Vincent's  Infant  Asylum 21 

University  Hospital 11 

Training  School  for  Nurses: 

Maryland  General  Hospital 76 

Mercy  Hospital 75 

University  Hospital 73 

University  Council 4 

University  of  Maryland: 
Department   of   Arts   and    Sciences    (St. 

John's  College) 82 

Department  of  Dentistry 82 

Department  of  Law 83 

Department  of  Pharmacy 83 

Young  Men's  Christian  Association 81 


MERCY  HOSPITAL 


COLLEGE   OF   PHYSICIANS  AND    SURGEONS 


UNIVERSITY    HOSPITAL 


MARYLAND    GENERAL   HOSPITAL 


THOMAS  A.  ASHBY 


BULLETIN 

OF  THE 

University  of  Maryland  School 
OF  Medicine 

AND 

College  of  Physicians  and 
Surgeons 

Successor  to  The  Hospital  Bulletin,  of  the  University  of  Maryland, 
Baltimore  Medical  College  News,  and  the  Journal  of  the  Alumni  Asso- 
ciation of  the  College  of  Physicians  and  Surgeons 

Vol.  I  OCTOBER,  1916  No.  3 

PROF.  THOMAS  A.  ASHBY,  M.D.,  LL.D. 
By  Randolph  Winslow,  A.M.,  M.D.,  LL.D. 

On  June  26,  1916,  after  a  lingering  illness.  Dr.  Thomas  Almond 
Ashby,  professor  of  diseases  of  women  since  1897,  succumbed  to  a 
complication  of  diseases.  Within  18  months  the  medical  school  has 
lost  seven  of  its  most  distinguished  and  most  useful  members — 
Chew,  Coale,  Spruill,  Streett,  Chandlee,  Ashby  and  Simon. 

The  death  of  Dr.  Ashby  removes  from  our  circle  another  link 
binding  us  with  the  past,  and  one  of  the  very  few  remaining  bonds 
connecting  the  new  with  the  old.  He  was  born  at  Front  Royal,  Va., 
on  November  18,  1848,  of  distinguished  ancestry.  While  he  was 
still  a  lad  the  Civil  War  broke  out,  and  though  too  young  to  take  the 
field,  he  saw  much  of  the  horror  and  desolation  that  overspread  the 
Southland,  and  especially  the  almost  constant  military  activities  that 
occurred  in  the  Valley  of  Virginia. 

His  experience  during  this  period  was  given  to  the  pubUc  in  1914 
in  an  interesting  volume  entitled  The  Valley  Campaigns.  During 
the  same  year  he  also  published  another  hook— Life  of  Turner  Ashby, 
being  a  biographical  sketch  of  his  distinguished  kinsman,  General 
Turner  Ashby,  C.S.A.  In  1867  Dr.  Ashby  entered  Washington 
College,  Virginia,  now  Washington  and  Lee  University,  during  the 
presidency  of  the  idoUzed  General  Robert  E.  Lee.     He  remained 

33 


34  RANDOLPH    WINSLOW 

there  three  years,  taking  an  elective  course  in  preparation  for  the 
study  of  medicine.  It  is  evident  that  he  made  good  use  of  his  op- 
portunities, as  he  acquired  a  varied  fund  of  information  which  he 
continued  to  augment  almost  to  the  end  of  his  Hfe.  While  he  was 
well  versed  in  the  classics,  his  especial  delight  was  history,  which  he 
read  with  avidity  and  with  a  philosophic  comprehension. 

In  October,  1871,  he  matriculated  as  a  medical  student  in  the 
University  of  Maryland,  and,  following  the  custom  of  those  days, 
graduated  two  years  later,  in  1873.  He  was  a  chnical  assistant  or 
House  Student  in  1872,  and  made  excellent  use  of  the  clinical  facili- 
ties of  the  old  Baltimore  Infirmary,  now  known  as  the  University 
Hospital. 

After  graduation  he  settled  in  Baltimore  and  began  the  practice  of 
his  profession,  but  in  1875  he  accepted  an  appointment  as  resident 
physician  to  the  infirmary,  which  he  retained  for  more  than  three 
years.  While  occupying  this  position  he  estabhshed  a  reputation 
for  executive  ability  and  professional  skill  which  were  the  foundation 
stones  of  a  successful  and  distinguished  career.  In  1877  he  estab- 
lished the  Maryland  Medical  Journal,  which  is  now  completing  its 
thirty-ninth  volume.  This  journal  has  had  a  longer  existence  than 
any  other  medical  periodical  ever  published  in  Maryland,  and  has 
been  of  great  value  to  the  physicians  of  the  state. 

In  1882  Dr.  Ashby  joined  with  several  others  in  estabhshing  The 
Woman's  Medical  College  of  Baltimore,  an  institution  for  the  ex- 
clusive training  of  women  in  medicine.  He  occupied  the  chair  of 
obstetrics  and  clinical  gynecology  in  this  small  but  reputablj  school 
until  1897. 

In  1889  he  was  called  to  the  chair  of  diseases  of  women  in  the 
Baltimore  Medical  College,  at  that  time  a  progressive  and  rapidly- 
growing  institution.  He  here  for  the  first  time  found  a  fertile  field 
for  the  cultivation  of  his  specialty  of  gynecology,  and  he  soon  ac- 
quired a  wide  reputation  as  a  facile  and  skillful  operator. 

Upon  the  resignation  of  Prof.  William  T.  Howard  in  1897  Dr. 
Ashby  was  unanimously  chosen  his  successor  as  professor  of  diseases 
of  women  in  the  University  of  Maryland,  which  position  he  continued 
to  fill  until  his  death.  He  entered  upon  his  duties  with  great  enthu- 
siasm and  earnestness,  and  with  a  constructive  ability  of  a  high  order. 
His  clinical  work  at  the  University  Hospital  attracted  much  atten- 
tion, not  only  on  account  of  the  extraordinary  celerity  with  which 
he  performed  difficult  abdominal  operations,  but  by  reason  of  the 


PROF.   THOMAS  A.  ASHBY,   M.D.,  LL.D.  35 

unusual  success  that  followed.     Though  stricken  with  a  mortal  ill- 
ness, he  continued  to  operate  almost  to  the  last. 

He  was  the  recipient  of  many  honors.  In  1890-1891  he  was 
president  of  the  Medical  and  Chirurgical  Faculty  of  Maryland,  this 
early  recognition  of  his  worth  having  been  due  to  the  fact  that  he 
had  succeeded  in  securing  122  new  members  for  the  faculty.  He 
had  also  been  president  of  most  of  the  local  medical  societies.  He 
was  elected  a  fellow  of  the  American  Gynecology  Society  in  1887, 
and  at  the  time  of  his  death  was  one  of  its  oldest  fellows.  He  was 
also  a  fellow  of  the  American  College  of  Surgeons,  and  one  of  its 
founders.  In  recognition  of  his  high  attainments  his  alma  mater, 
Washington  and  Lee  University,  conferred  the  LL.D.  degree  on 
him  a  few  years  ago. 

In  1912  he  was  elected  a  member  of  the  House  of  Delegates  of  the 
Maryland  Legislature,  and  he  served  so  faithfully  that  he  was  not 
renominated.  In  addition  to  his  vast  literary  labors  as  editor  of  the 
Maryland  Medical  Journal,  and  later  of  the  Hospital  Bulletin,  of 
the  University  of  Maryland,  he  was  a  frequent  contributor  to  the 
medical  journals,  and  in  1903,  he  brought  out  a  textbook  on  diseases 
of  women.  Unfortunately,  almost  the  entire  edition  of  this  work 
was  destroyed  by  fire  in  the  great  conflagration  that  occurred  in 
Baltimore  in  February,  1904,  and  he  never  found  time  or  inclina- 
tion to  reproduce  the  work. 

His  efforts  in  behalf  of  the  University  of  Maryland  were  always 
constructive,  and  we  trusted  him  to  pull  us  out  of  many  difficulties, 
and  our  trust  was  never  misplaced.  A  noteworthy  characteristic 
of  Dr.  Ashby  was  his  unfaihng  optimism.  If  the  cloud  was  dark, 
he  could  see  the  silver  lining  where  the  rest  of  us  could  only  see  an 
impending  storm.  Optimism  is  always  an  impelling  force  which  in- 
cites to  effort,  while  pessimism  is  a  clog  that  stays  the  wheels  of 
progress.  His  optimism  was  not  a  passive  virtue,  but  an  active 
principle  which  enabled  him  not  only  to  devise  plans,  but  to  put 
them  into  successful  operation.  No  account  of  Dr.  Ashby  would  be 
complete  without  reference  to  his  courtesy,  great  kindliness,  geni- 
ality, affability  and  friendliness. 

He  was  a  gentleman  of  the  old  school. 


36  ALEXIUS  McGLANNAN 

A  Special  Meeting,  of  the  Faculty  of  Physic  was  held  on  June 
27,  1916. 

Dr.  Winslow,  in  the  Chair,  explained  that  he  had  called  this 
special  meeting  of  the  Faculty  of  Phj-sic  to  take  action  on  the  death 
of  our  colleague,  Prof.  Thomas  A.  Ashby. 

Dr.  Merrick  offered  a  resolution,  requesting  all  members  of  the 
Faculty  to  attend  the  funeral  services  on  Wednesday,  June  28, 
at  5  p.m. 

Dr.  Friedenwald  moved  that  the  President,  Dr.  Winslow,  and 
Drs.  Merrick  and  Warfield,  be  apppointed  a  special  committee  to 
prepare  suitable  resolutions  expressive  of  the  sense  of  loss  of  the 
Faculty  cf  Physic  at  the  death  of  Doctor  Ashby;  that  these  be  made 
a  part  of  our  minutes,  that  a  copy  be  sent  to  the  family,  and  that 
the  committee  publish  them  in  the  University  Publications,  and 
in  the  daily  press.     This  motion  was  adopted. 

The  meeting  then  adjourned. 

[Signed]  Harry  Friedenwald, 

Secretary  pro  tern. 

The  Faculty  of  Physic  of  the  University  of  Maryland  desires  to  place  on 
record  its  great  sorrow  on  the  death  of  its  late  member,  Prof.  Thomas  Almond 
Ashby,  M.D.,  LL.D.,  as  well  as  its  appreciation  of  the  many  and  varied  at- 
tributes of  mind  and  heart  that  were  such  prominent  features  in  his  character. 

The  services  of  Dr.  Ashby  to  the  University  were  always  constructive  and 
of  great  value.  He  abounded  in  optimism  and  had  a  firm  faith  in  the  des- 
tinies of  the  institution,  and  his  death  at  this  time  entails  a  severe  loss  on 
the  School. 

It  further  desires  to  give  expression  to  its  appreciation  of  his  loyalty  as 
a  friend,  his  courtesy  as  a  gentleman  and  his  unfailing  kindness  to  everyone. 

Graduating  from  the  University  of  Maryland  in  1873.  he  was  elected  pro- 
fessor of  the  diseases  of  women  in  1897,  after  having  occupied  a  similar  chair 
in  the  Baltimore  Medical  College  for  nine  years.  In  both  of  these  responsible 
positions  he  measured  up  to  a  high  degree  of  efficiency. 

Be  it  Resolved,  That  these  resolutions  be  spread  on  the  minutes  of  the 
Faculty  and  that  a  copy  of  the  same  be  sent  to  the  family  of  Professor  Ashby. 

James  M.  H.  Rowland,  Dean. 

PROF.  WILLIAM  SIMON,  Ph.D.,  M.D.  Sc.D.,  LL.D. 
By  Alexius  McGlannan,  A.M.,  M.D. 
Dr.   William  Simon,   Professor  of  Chemistry,  died  of  nephritis 
July  19,  1916,  at  his  summer  home,  Eaglesmere,  Pa. 

Dr.  Simon  was  born  at  Eberstadt,  Germany,  February  20,  1844. 
He  was  educated  at  Giessen,  receiving  the  degree  of  Doctor  of 
Philosophy  from  that  Universit}^  in  1869. 


WILLIAM  SIMON 


PROP.  WILLIAM  SIMON,  PH.D.,  M.D.,  SC.D.,  LL.D.  37 

After  a  year  as  assistant  to  Prof.  H.  Will  at  the  University,  Dr. 
Simon  came  to  Baltimore  in  November,  1870,  as  chemist  in  charge 
of  the  Baltimore  Chrome  Works. 

The  desire  to  teach,  a  strong  factor  of  Dr.  Simon's  character, 
manifested  itself  in  the  organization  of  a  class  in  analytical  chemis- 
try during  the  spring  of  1871.  The  meetings  were  held  in  one  of 
the  rooms  of  the  Maryland  College  of  Pharmacy;  and  with  this 
class  he  instituted  the  first  laboratory  in  Baltimore  to  be  devoted 
to  the  teaching  of  chemistry.  The  class  included  a  number  of  dis- 
tinguished post-graduate  scholars,  among  others,  Joseph  Roberts, 
Louis  Dohme,  George  Forster  and  Charles  Caspari,  Jr. 

From  this  beginning  came'  the  successive  calls  to  the  Chair  of 
Chemistry  in  the  Maryland  College  of  Pharmacy  in  1872,  the  Col- 
lege of  Physicians  and  Surgeons  in  1880,  and  the  Baltimore  College 
of  Dental  Surgery  in  1888. 

As  a  natural  result  of  his  teaching  positions,  there  came  out  in 
1884,  Simon's  Manual  of  Chemistry.  This  really  wonderful  book 
has  been  the  introduction  to  science  for  thousands.  For  many 
years  it  stood  alone  in  its  unique  field.  Even  now,  in  spite  of  a 
multitude  of  competitors,  and  the  great  changes  that  have  been 
made  in  the  entrance  requirements  of  the  colleges,  it  remains,  in  its 
tenth  edition,  the  most  intelUgible  introduction  for  average  stu- 
dents of  medicine  and  the  allied  arts  and  sciences. 

Dr.  Simon  possessed  in  a  remarkable  degree  the  ability  to  put 
into  popular  language  the  abstruse  facts  of  science,  as  well  as  the 
explanation  of  their  practical  application.  All  who  knew  him  will 
recall  the  delightfully  entertaining  lectures  and  demonstrations  with 
Liquid  Air,  Wireless  Telegraphy  and  Color  Photography.  A  pioneer 
in  the  last  named  art,  he  found  great  enjoyment  in  its  practice, 
and  unending  pleasure  in  exhibiting  his  beautiful  pictures  for  the 
edification  of  his  friends. 

With  a  prescience  that  now  seems  occult,  Dr.  Simon  retired  from 
his  professorship  at  the  close  of  the  last  scholastic  year.  For  many 
his  last  appearance  was  at  the  Commencement  Exercises  of  the 
University,  where  the  Degree  of  Doctor  of  Laws  was  conferred  on 
him.  This  latest  honor  came  a  year  after  the  University  of  Penn- 
sylvania had  conferred  the  Degree  of  Doctor  of  Science. 

Dr.  Simon's  charming  qualities  of  mind  and  manner  endeared 
him  to  all  with  whom  he  came  into  close  contact.  His  home  life 
was  sweet  and  simple,  filled  with  devotion  for  his  beloved  wife, 


38  ALEXIUS  McGLANNAN 

who  survives  him.  Many  of  us  well  remember  their  delightful 
hospitality  and  the  pleasant  associations  of  a  visit  to  their  home. 
Scattered  throughout  the  faculties  of  the  University  at  this  time, 
in  man}^  departments,  men  are  serving  who  began  their  teaching 
careers  as  assistants  or  associates  to  Dr.  Simon.  To  these  men  in 
particular  he  was  the  Wise  Teacher,  the  Just  Master  and  the  Kind 
Friend.  As  long  as  they  are  guided  by  his  ideals,  and  profit  by  his 
example,  the  University  will  hold  within  itself  monuments  to  his 
memory  more  enduring  than  marble,  tablets  in  his  honor,  brighter 
than  burnished  brass. 

A  special  meeting  of  the  Faculty  of  Physic  of  the  University  of 
Maryland  School  of  Medicine  and  College  of  Physicians  and  Sur- 
geons was  held  on  July  21,  1916,  in  order  to  take  action  on  the  death 
of  Dr.  Wilham  Simon. 

Dr.  Harry  Friedenwald  and  Dr.  Lockwood  were  appointed  a 
committee  to  draw  up  suitable  resolutions.  The  committee  pre- 
sented the  following  minute,  which  was  approved,  and  the  Dean 
instructed  to  pubhsh  the  same  in  the  public  press  and  send  a  copy 
to  the  family  of  Dr.  Simon. 

Professor  William  Simon  was  a  member  of  the  Faculty  of  the  College  of 
Physicians  and  Surgeons  for  more  than  a  third  of  a  century.  He  was  a  scien- 
tist of  distinction,  a  teachar  of  rare  ability  and  enthusiasm,  and  he  made  his 
department,  that  of  Chemistry,  widely  and  favorably  known  throughout 
the  land.  His  Manual  of  Chemistry  has  long  been  one  of  our  most  popu- 
lar text  books.  Having  brought  with  him  the  highest  ideals  of  university 
teaching  from  his  native  country,  his  interests  in  Medical  Education  went  far 
beyond  the  limits  of  his  own  department,  and  no  one  connected  with  our 
institution  has  done  more  than  he  to  elevate  the  standard  of  medical  instruc- 
tion. 

Aside  from  these  activities.  Professor  Simon  exerted  a  profound  influence 
upon  vast  numbers  of  men  with  whom  he  came  into  relation  as  colleague, 
as  teacher  and  as  friend.  He  was  beloved  by  them  because  of  his  rare  and 
attractive  qualities  of  mind  and  heart.  He  was  kind  and  generous  in  dealing 
with  the  faults  of  others,  and  was  always  ready  to  give  abundantly  of  his 
time,  his  means  and  knowledge  to  those  who  required  his  help.  He  was  a 
loyal  and  helpful  friend,  full  of  kind  sympathy.  He  was  a  man  of  the  high- 
est honor. 

We  who  have  been  his  colleagues  mourn  his  death,  and  shall  ever  cherish 
his  memory.  To  his  bereaved  widow  and  relatives  we  extend  our  profound 
sympathy  and  our  condolence. 

[Signed]  J.  M.  H.  Rowland, 
Dean. 


FURTHER  OBSERVATIONS   ON  THE  VALUE   OF 

SCARLET  RED    IN   THE  TREATMENT   OF 

GASTRIC   AND   DUODENAL  ULCER.i 

By  Julius  Feiedenwald,  M.D. 

Professor  of  Gastroenterology 


T.  F.  Leitz,  M.D. 

Associate  Professor  of  Gastroenterology 

University  of  Maryland  School  of  Medicine  and  College  of 

Physicians  and  Surgeons,  Baltimore,  Md. 

In  a  paper  published  two  years  ago^  we  reported  the  result  of 
treatment  of  thirty-seven  cases  of  peptic  ulcer  with  scarlet  red, 
advocating  the  use  of  this  drug  not  as  displacing  the  time-honored 
rest  cure  treatments  of  Leube  or  the  more  recent  cure  of  Lenhartz, 
but  simply  recommending  its  employment  as  a  useful  adjuvant 
in  the  treatment  of  this  affection. 

In  this  paper  we  noted  the  fact  that  John  Staige  Davis  was  the 
first  to  suggest  the  use  of  this  drug  in  the  treatment  of  ulcer  of  the 
stomach  and  to  prove  its  usefulness  experimentally  in  animals. 

Scarlet  red  has  the  scientific  name  tolueneazotolueneazo-betanapthol 
and  is  made  by  a  combination  of  amidazotoluol  and  betanapthol  and  has 
the  formula, 

CHs  CH3 

CHe  +  N  =  N  -  CeHs  -  N  =  N  -  CioHeOH  (Beta). 

It  is  a  reddish-brown  powder  and  gives  a  scarlet  red  color  in  oil  solutions. 
The  powder  as  well  as  the  oil  solution  is  tasteless.  Scarlet  red  is  insoluble 
in  water,  but  is  soluble  in  alcohol,  ether,  and  olive  oil. 

Davis's  conclusions  as  to  the  effect  of  this  substance  are  as  follows : 

The  dyestuff  used  in  this  series  of  experiments  is  not  toxic  and  apparently 
has  no  deleterious  effect  on  either  dogs  or  rabbits.  When  given  by  the  mouth 
it  is  a  fat-selecting  vital  stain.  In  the  course  of  months  the  stain  is  gradually 
eliminated.  Subcutaneous  and  intraperitoneal  injections  stain  only  the  fat 
in  actual  contact  with  the  scarlet-red  oil  solution.     It  is  difficult  to  say  from 

^  Reprinted  from  the  Medical  Record,  July  22,  1916. 

2  Friedenwald  and  Leitz :  On  the  Effect  of  Scarlet  Red  in  the  Treatment 
of  Gastric  and  Duodenal  Ulcer,  Monthly  Cijclopedia  and  Medical  Bulletin, 
June,  1913. 

39 


40  JULIUS  FRIEDENWALD  AND  T.   F.   LEITZ 

these  operative  experiments  whether  the  scarlet  red  has,  or  has  not,  a  defin- 
ite stimulating  action  on  the  epithelium  of  defects  in  the  gastric  mucosa. 
However,  the  scarlet-red  oil  solution  caused  a  more  rapid  and  better  developed 
growth  of  epithelium  in  the  group  in  which  it  was  used  than  occurred  in  the 
duplicate  group  where  plain  olive  oil  was  used.  The  results  with  dry  powder 
were  not  so  favorable  experimentally,  but  this  may  have  been  due  to  the  fact 
that  the  material  was  not  continuously  in  contact  with  the  denuded  area. 
We  were  unable  to  determine  the  relative  effect  of  the  scarlet  red  on  chronic 
gastric  ulcers,  as  it  was  impossible  to  produce  chronic  ulcers  in  dogs  with 
(Controls  of  exactly  the  same  size.  Our  experiments  are  suggestive,  and,  as 
this  dyestuff  may  be  safely  administered,  we  feel  that  it  is  worthy  of  a  thorough 
clinical  trial. 

According  to  our  observations  scarlet  red  may  be  administered 
in  doses  of  from  15  to  20  grains,  three  or  four  times  daily,  without 
producing  the  slightest  toxic  effect,  provided  a  pure  preparation 
be  employed  (Biebrich).  It  is  best  given  in  7^  grain  cachets,  two 
of  which  may  be  taken  three  or  four  times  daily  before  meals.  It 
may,  however,  be  administered  in  much  larger  doses,  and  only 
after  very  large  continuous  doses  can  the  odor  of  camphor  be  de- 
tected in  the  urine.  Not  the  slightest  toxic  effect  of  this  drug 
could  be  observed  in  any  instance  during  its  emplojinent  in  over 
one  hundred  patients. 

We  leported  the  results  of  treatment  of  thirty-seven  cases  of 
ulcer  in  which  scarlet  red  was  employed  in  the  course  of  treatment. 
In  the  largest  proportion  of  these  cases  a  most  beneficial  effect  seems 
to  have  been  obtained  from  its  use.  From  the  use  of  the  remedy 
the  following  conclusions  were  drawn: 

1.  Scarlet  red  is  a  useful  adjuvant  in  the  treatment  of  peptic  ulcer. 

2.  Wliile  it  cannot  replace  the  usual  forms  of  treatment,  when 
it  is  administered  in  conjunction  with  them  it  frequently  renders 
the  cure  more  effective. 

3.  As  a  help  in  the  treatment  of  ambulatory  cases  it  is  of  great 
service,  and  its  effect  seems  to  be  even  more  favorable  than  that 
obtained  from  bismuth. 

4.  Its  use  need  not  in  any  way  interfere  with  the  administration 
of  other  remedies,  such  as  the  alkalies  or  belladonna,  when  indi- 
cated, and,  in  fact,  the  effect  of  the  combination  is  at  times  most 
beneficial. 

Since  this  publication,  the  use  of  this  remedy  has  been  noted 
by  other  observers.     Zeublin^  found  it  of  value  in  a  case  of  gastric 

3  Zeublin:  Transactions  of  the  American  Therapeutic  Society,  1913,  p.  114. 


THE  VALUE  OF  SCARLET  RED  41 

ulcer  with  hemorrhage.  Einhorn'*  points  out  its  use  in  gastric  and 
duodenal  ulcer  and  Jones^  has  employed  it  along  with  the  duodenal 
tube  feeding,  a  daily  dose  of  scarlet  red  in  capsule  being  given  by 
mouth,  along  the  side  of  the  tube  with  apparently  good  results. 

We  have  since  employed  this  remedy  in  forty-five  more  cases 
of  ulcer  with  equally  favorable  results.  As  in  the  last  report  we 
have  not  included  those  cases  in  which  the  Leube  or  Lenhartz 
cure  had  been  undertaken  and  which  have  made  uneventful  re- 
coveries, inasmuch  as  most  of  such  cases  would  have  recovered 
without  the  help  of  any  drug  whatsoever;  but  have  included  only 
those  in  which  the  result  of  the  rest  cure  was  unsatisfactory  and 
have  added  the  ambulatory  cases  of  ulcer,  which  remained  unbene- 
fited  by  the  usual  treatment. 

Of  these  cases  in  which  the  remedy  was  employed  sixteen  were 
treated  by  the  Leube  rest  cure,  eighteen  by  the  Lenhartz  treatment 
and  eleven  were  ambulatory  cases.  Of  those  treated  by  the  Leube 
cure  thirteen  or  28.8  per  cent  were  cured;  two  or  4.4  per  cent  were 
relieved  and  one  or  2.2  per  cent  was  not  relieved.  Of  those  treated 
by  the  Lenhartz  method  fourteen  or  3L1  per  cent  were  cured; 
two  or  4.4  per  cent  were  relieved  and  two  or  4.4  per  cent  were  not 
relieved.  Of  those  given  ambulatory  treatment  four  or  8.8  per  cent 
were  cured;  four  or  8.8  per  cent  were  relieved  and  three  or  6.6  per 
cent  were  not  cured. 

When  we  consider  the  fact  that  all  of  these  cases  resisted  the 
usual  treatment  (that  is,  were  treated  by  the  usual  methods  first 
and  were  not  relieved  until  the  scarlet  red  had  been  administered), 
the  result  is  most  encouraging.  The  results  obtained  are  much 
hke  those  noted  in  our  first  report. 

The  results  of  treatment  in  the  forty-five  cases  in  which  scarlet 
red  was  utilized  are  illustrated  in  the  accompanying  table.  In  it 
are  noted  respectively  the  location  of  the  ulcer,  the  dose  of  scarlet 
red  administered,  the  duration  of  treatment  and  its  effect. 

From  our  experience  with  this  remedy  in  the  treatment  of  the 
forty-five  cases  of  peptic  ulcer  just  noted,  together  with  the  results 
of  the  thirty-seven  cases  already  reported,  we  believe  we  are  justi- 
fied in  drawing  the  following  conclusions: 

1.  Scarlet  red  still  remains  a  useful  adjuvant  in  the  treatment 
of  peptic  ulcer  and  while  it  cannot  by  any- means  replace  the  usual 

^Einhorn:  Medical  Record,  July  18,   1914. 

»  Jones :  Transactions  American  Gastro-Enterological  Association,   1915. 


Table  Illustrating  the  Effect  of  Scarlet  Red  in  the  Treatment  of  Forty-Five  Cases 

of  Peptic  Ulcer 


NO. 

NAME 

AGE 

SEX 

DIAGNOSIS 

FORM  OF 
TREATMENT 

BS 
S 
h 
an 

a 

6.  Z 

z  z 
ow 

"  2  [0 
H  5  W 

<    rl    W 
&    H    ? 

0 

RESULTS 

1 

J.S. 

22 

M. 

Duodenal 

Leube 

45 

4 

Cured 

2 

T.F. 

34 

M. 

Gastric 

Lenhartz 

30 

6 

Not  relieved 

3 

C.L. 

26 

M. 

Duodenal 

Lenhartz 

60 

4 

Cured 

4 

H.T. 

20 

F. 

Duodenal 

Lenhartz 

45 

3 

Cured 

5 

L.P. 

52 

M. 

Gastric 

Leube 

45 

4 

Cured 

6 

P.A. 

64 

F. 

Gastric 

Leube 

60 

5 

Cured 

7 

J.J. 

58 

F. 

Duodenal 

Lenhartz 

45 

4 

Cured 

8 

J.S. 

44 

M. 

Gastric 

Ambulatory 

30 

6 

Cured 

9 

F.B. 

49 

M. 

Duodenal 

Lenhartz 

40 

4 

Cured 

10 

K.S. 

62 

M. 

Duodenal 

Leube 

45 

5 

Cured 

11 

T.M. 

57 

F. 

Duodenal 

Lenhartz 

60 

3 

Cured 

12 

N.P. 

61 

M. 

Gastric 

Ambulatory 

45 

5 

Relieved 

13 

B.K. 

47 

M. 

Duodenal 

Lenhartz 

40 

4 

Cured 

14 

O.T. 

29 

F. 

Duodenal 

Ambulatory 

60 

6 

Not  relieved 

15 

R.M. 

38 

F. 

Gastric 

Leube 

45 

4 

Cured 

16 

M.F. 

47 

F. 

Duodenal 

Lenhartz 

60 

5 

Cured 

17 

K.W. 

52 

M. 

Duodenal 

Lenhartz 

45 

4 

Relieved 

18 

P.P. 

59 

M. 

Gastric 

Leube 

30 

3 

Cured 

19 

J.H. 

28 

F. 

Duodenal 

Leube 

45 

6 

Cured 

20 

W.C. 

71 

M. 

Duodenal 

Leube 

60 

4 

Relieved 

21 

L.D. 

42 

M. 

Gastric 

Ambulatory 

40 

5 

Cured 

22 

P.B. 

64 

F. 

Duodenal 

Lenhartz 

40 

5 

Cured 

23 

A.F. 

54 

F. 

Gastric 

Ambulatory 

60 

7 

Relieved 

24 

T.B. 

49 

M. 

Duodenal 

Leube 

60 

8 

Cured 

25 

L.K. 

37 

F. 

Duodenal 

Ambulatory 

45 

4 

Not  relieved 

26 

O.F. 

52 

M. 

Duodenal 

Lenhartz 

45 

6 

Not  relieved 

27 

B.C. 

40 

M. 

Gastric 

Ambulatory 

40 

5 

Relieved 

28 

D.M. 

47 

F. 

Duodenal 

Leube 

60 

4 

Cured 

29 

E.P. 

69 

M. 

Duodenal 

Lenhartz 

60 

3 

Cured 

30 

G.C. 

43 

F. 

Gastric 

Leube 

40 

6 

Not  relieved 

31 

M.F. 

38 

M. 

Duodenal 

Lenhartz 

45 

6 

Cured 

32 

O.L. 

54 

F. 

Duodenal 

Leube 

60 

8 

Cured 

33 

R.S. 

56 

F. 

Gastric 

Leube 

45 

7 

Cured 

34 

s.v. 

37 

F. 

Duodenal 

Lenhartz 

60 

3 

Cured 

35 

B.B. 

68 

M. 

Duodenal 

Lenhartz 

45 

4 

Cured 

36 

G.K. 

44 

M. 

Duodenal 

Leube 

40 

6 

Cured 

37 

L.G. 

47 

M. 

Gastric 

Ambulatory 

40 

2 

Cured 

38 

K.B. 

52 

M. 

Duodenal 

Lenhartz 

60 

4 

Relieved 

39 

J.S. 

38 

F. 

Gastric 

Ambulatory 

45 

7 

Not  relieved 

40 

M.R. 

62 

M. 

Duodenal 

Lenhartz 

60 

6 

Cured 

41 

F.S. 

56 

F. 

Gastric 

Leube 

45 

8 

Relieved 

42 

O.P. 

29 

M. 

Gastric 

Ambulatory 

45 

4 

Cured 

43 

N.K. 

31 

M. 

Duodenal 

Leube 

40 

4 

Cured 

44 

B.C. 

43 

F. 

Duodenal 

Ambulatory 

60 

6 

Relieved 

45 

C.F. 

25 

M. 

Duodenal 

Lenhartz 

45 

7 

Cured 

42 


FOREIGN  STUDENTS  AT  THE  UNIVERSITY  OF  MARYLAND  43 

forms  of  treatment,  when  administered  in  conjunction  with  them, 
it  adds  materially  to  the  effectiveness  of  the  cure. 

2.  It  is  of  great  help  when  administered  in  the  ambulatory  cases, 
the  effect  being  even  more  favorable  than  the  usual  remedies,  such 
as  bismuth. 

3.  Inasmuch  as  scarlet  red  in  no  way  interferes  with  the  adminis- 
tration of  other  remedies,  such  as  the  alkalies  or  atropine,  these 
may  be  administered  when  indicated  at  the  same  time  and  in  fact, 
the  effect  of  the  combination  is  at  times  most  beneficial. 

FOREIGN  STUDENTS  AT  THE  UNIVERSITY  OF 
MARYLAND 

Caleb  Winslow,  A.M.,  Registrar 

At  some  colleges  the  arrival  of  a  foreign  student  causes  a  flutter 
of  excitement,  and  is  even  the  occasion  for  a  lengthy  press  notice. 
This  is  not  true  of  the  University  of  Maryland,  unless  as  one  appli- 
cant said  of  himself,  "black  blood  flows  by  his  veins,"  in  which  case 
he  is  politely  requested  to  withdraw.  During  the  session  of  1915-16 
our  enrolment  for  all  the  departments  included  eighty-eight  stu- 
dents from  thirty  different  foreign  countries  and  dependencies. 
This  in  itself  explains  why  the  foreigner  excites  so  little  curiosity 
here,  he  is  no  novelty.  The  distribution  of  these  students  was  as 
follows : 

Porto  Rico 18  China 6 

Cuba 14  Cana  la 5 

Russia 12  Italy 3 

Germany,  Mexico,  Philippine  Islands,  Poland,  Palestine,  and 
Lithuania,  2  each.  Nicaragua,  France,  Greece,  Ireland,  Japan, 
Brazil,  Venezuela,  Serbia,  South  Africa,  Spain,  Jamaica,  Trinidad, 
Switzerland,  Honduras,  New  Zealand,  England,  Costa  Rico,  and 
Dutch  West  Indies,  1  each. 

At  the  present  time  there  is  every  indication  that  the  roster  for 
1916-17  will  include  foreign-born  students  in  even  greater  numbers 
and  from  an  equally  interesting  variety  of  nations.  This  is  partic- 
ularly the  case  with  reference  to  South  America.  A  recent  letter 
from  a  Consul  in  Brazil  stated  that,  owing  to  the  extraordinary  condi- 
tions in  Europe,  Brazihan  students  desiring  to  enter  the  professions 
were  clamoring  for  information  concerning  American  universities. 


44  DR.   FRIEDENWAID  BACK  FROM  BORDER 

Now  is  the  opportune  time  for  us  to  reach  the  students  of  the 
southern  repubHcs.  If  we  once  succeed  in  making  the  University 
of  Maryland  favorably  known  in  that  part  of  the  world,  streams  of 
students  will  continue,  siphon-like,  to  flow  to  our  doors  without  any 
further  effort  on  our  part  even  after  the  European  universities  are 
again  in  normal  operation. 

DR.  E.  B.  FRIEDENWALD  BACK  FROM  BORDER 

Dr.  Edgar  B.  Friedenwald,  of  1616  Linden  Avenue,  returned  today 
from  two  months  and  a  half  spent  in  active  service  with  the  Twenty- 
sixth  Infantry  at  San  Benito  and  Harhngton,  Texas,  as  a  member 
of  the  Army  Medical  Reserve  Corps.  Although  he  was  once  in  the 
grip  of  a  hurricane  which  blew  at  the  rate  of  80  miles  an  hour,  al- 
though he  spent  one-third  of  the  time  while  he  was  away  in  garments 
that  were  soaking  wet  and  although  he  suffered  the  dengue  or  break- 
bone  fever,  he  saw  no  bloodshed  and  brought  back  no  tales  of  the 
bloodthirstiness  of  the  Mexicans. 

"To  be  sure,  I  saw  a  great  many  Mexicans,"  said  Dr.  Friedenwald, 
"We  were  only  a  few  miles  from  the  border  and  a  large  portion  of 
the  population  is  made  up  of  Mexicans.  But  all  whom  I  saw  were 
very  friendly  to  the  Americans.  And  there  were  any  number  of 
beautiful  little  children,  who  made  one  think  that  Murillo  must 
have  gone  to  Mexico  for  the  children  he  has  put  in  his  paintings. 
I  think  that  the  Texas  Rangers,  who  do  a  lot  of  swaggering,  are  re- 
sponsible for  much  of  the  trouble  on  the  border. 

"Just  before  I  got  to  Texas,  Mexican  bandits  had  crossed  the 
border  and  raided  the  railroad  on  which  we  were  and  the  Twenty- 
sixth  Infantry  was  guarding  that  and  the  pumping  stations  for  the 
water  supply  on  the  Rio  Grande.  We  had  detachments  posted  at 
culverts  on  the  road  and  at  the  pumping  stations. 

"The  hurricane  which  visited  the  camp  on  August  16  was  one  of 
the  most  exciting  experiences  I  have  ever  been  through.  It  had 
rained  very  hard  all  through  the  night  before  the  hurricane  came. 
Early  the  next  morning  we  got  warning  that  it  was  bound  our  way, 
and  about  6  o'clock  that  evening  it  broke.  We  were  forced  to 
desert  our  camp. 

"Tents  were  blown  down  and  the  canvas  torn  to  shreds.  All  our 
belongings  were  scattered.  It  was  impossible  to  stand  up  against 
the  wind,  which  was  blowing  at  the  rate  of  80  miles  an  hour,  and  we 


DR.  FRIEDENWALD  BACK  FROM  BORDER  45 

took  refuge  in  a  Methodist  church.  The  chimney  was  blown  off; 
that  and  rain  came  through.  We  laid  down  in  several  inches  of 
water  to  sleep  that  night.  We  were  dripping  wet  for  24  hours  and 
I  was  very  much  afraid  that  the  men  would  develop  pneumonia. 
But  they  didn't.  The  water  was  warm.  The  next  day  we  got  our 
torn  and  scattered  camp  together,  and  the  night  after  the  hurricane 
we  were  sleeping  in  tents  again. 

"The  health  of  the  troops  was  good.  There  was  no  typhoid 
fever,  although  some  para-typhoid,  which  is  spread  by  the  mosquito 
and  resembles  malaria.  It  is  not  as  deadly  as  typhoid.  There  was 
a  great  deal  of  the  dengue,  or  breakbone  fever.  The  latter  is  not 
dangerous,  although  it  is  extremely  trying  while  one  is  suffering 
from  it.  It  causes  the  most  exquisite  pain.  You  really  think  your 
bones  are  going  to  break,  the  torture  is  so  great.  It  usually  lasts 
about  two  weeks  and  leaves  the  sufferer  exhausted.  But  I  do  not 
think  there  were  any  deaths  from  it  while  I  was  in  Texas. 

"At  first  the  hospital  accommodations  were  not  very  good,  but 
later  the  base  hospitals  established  at  Brownsville  and  elsewhere 
took  good  care  of  the  sick.  If  hostilities  had  occurred  immediately 
after  the  troops  were  sent  to  the  border  the  facilities  for  caring  for 
the  wounded  would  have  been  inadequate.  They  were  very  much 
better  organized  later." 

The  above  article  is  abstracted  from  the  Evening  Sun  of  Septem- 
ber 13,  1916. 


BULLETIN 

OF    THE 

University  of  Maryland  School  of  Medicine 

AND 

College  of  Physicians  and  Surgeons 


Publication  Committee 

Randolph  Winslow,  A.M.,  M.D.,  LL.D.  Wm.  S.  Gardner,  M.D. 

J.  M.  H.  Rowland,  M.D. 

Nathan  Winslow,  A.M.,  M.D.,  Editor 

Ass  dale  Editors 

A' BERT  H.  Carroll,  M.D.  Andrew  C.  Gillis,  A.M.,  M.D. 

John  Evans,  M.D. 


The  Editor  of  the  "Bulletin" 

Dr.  Nathan  Winslow,  the  editor  of  the  Bulletin,  is  a  member  of 
the  Medical  Reserve  Corps  of  the  U.  S.  A.,  with  the  rank  of  first 
lieutenant.  On  July  1  he  was  assigned  to  active  duty,  and  two 
days  later  was  ordered  to  proceed  to  Fort  Sam  Houston,  Texas,  and 
report  to  the  commanding  officer.  Arranging  his  private  affairs  as 
well  as  he  could,  Lieutenant  Winslow  obeyed  the  call  of  duty  and 
reached  Fort  Sam  Houston  on  the  ninth  of  July.  He  was  there 
ordered  to  proceed  to  the  Third  Field  Hospital,  on  the  line  of  com- 
munication in  Mexico.  We  do  now  know  exactly  where  this  hos- 
pital is  located,  but  think  it  is  at  Co'onia  Dublan,  some  distance 
below  the  border.  In  thus  accepting  active  service.  Lieutenant 
Winslow  was,  perfolrce,  obliged  to  sacrifice  his  many  interests,  air.ong 
which  is  the  editorship  of  the  Bulletin.  The  Bulletin,  however, 
will  appear  as  usual,  and  will  be  conducted  by  other  members  of 
the  staff.  We  hope  that  Dr.  Winslow  may  have  a  useful  and  satis- 
factory service  in  the  army;  that  he  may  escape  rattlesnakes,  taran- 
tulas, scorpions,  coyotes  and  Mexicans,  as  well  as  the  diseases  inci- 
dent to  the  tropics  and  to  camp  life,  and  that,  having  served  his 
country  in  its  time  of  need,  he  may  return  to  the  peaceful  avocations 
of  civil  life  with  an  enlarged  experience,  a  broader  outlook  and  a 
still  greater  capacity  for  useful  service  to  the  community. 


46 


EDITORIALS 


47 


THE  CALL  TO  ARMS  AND  THE  UNIVERSITY 

On  June  21,  1916,  President  Wilson  sounded  the  tocsin  calling  the 
organized  troops  into  active  service.  The  Maryland  line,  as  of  yore, 
sprang  to  arms  and  went  into  camp  at  Laurel,  whence  they  were 
ordered  to  Eagle  Pass,  Texas.  The  First,  Fourth  and  Fifth  regi- 
ments infantry.  Troop  A  cavalry.  First  Field  Hospital  and  First 
Ambulance  Company  forming  the  1st  Brigade,  under  command  of 
Brigadier-General  Charles  D.  Gaither,  were  sent  to  the  Rio  Grande 
and  have  been  in  active  duty  since  the  early  part  of  July.     A  bat- 


48  EDITORIALS 

tery  of  field  artillery  was  sent  to  Tobyhanna,  Pa.,  to  a  camp  of  in- 
struction and  is  still  there.  In  these  various  units  are  many  men 
who  are  or  have  been  connected  with  the  various  schools  forming  the 
University  of  Maryland.  Saint  John's  College  students  to  a  large 
extent  are  found  in  the  machine  gun  company  of  the  First  Regiment, 
though  some  of  them  are  also  to  be  found  in  other  organizations. 
Men  from  other  departments  are  also  to  be  found  with  the  troops 
but  practically  the  entire  Medical  Staff  of  the  Maryland  Brigade 
has  been  supplied  by  the  University  and  its  affihated  schools.  The 
chief  surgeon  of  the  brigade  is  Major  Robert  P.  Bay,  who,  however, 
has  been  detailed  to  recruiting  duty  and  did  not  accompany  the 
brigade  south.  Major  S.  Griffith  Davis  is  chief  surgeon  of  the  Fifth 
Regiment,  Major  Herbert  C.  Blake  of  the  Fourth,  and  Major  J.  Harry 
Ulrich  of  the  First  Field  Hospital.  Associated  with  these  are  Cap- 
tains G.  Milton  Linthicum,  Jacob  Madara,  Wm.  J.  Colen.an,  F. 
H.  Vinup,  J.  C.  Stansbury;  Lieutenants  Caldwell  Woodruff,  Chas. 
W.  Rauschenbauch,  R.  W.  Johnson,  Dan  C.  Hutton  and  Geo.  W. 
Rice,  and  others  whom  we  do  not  recall  at  this  time. 

But  not  alone  in  the  National  Guard  do  we  find  our  men  but  a 
number  of  these  who  are  members  of  the  Medical  Rese'rve  Corps 
have  been  assigned  to  active  service  with  the  regulars.  Lieutenant 
Nathan  Winslow  is  with  General  Pershing's  Punitive  Expedition  in 
Mexico,  Lieutenants  Duncan  McCalman  and  Walter  A.  Ostendorf 
are  on  the  border  and  Lieutenant  Edgar  Friedenwald  was  stationed 
on  the  lower  Rio  Grande  near  Brownsville  but  has  now  returned 
home.  Dr.  Wm.  A.  Boyd  has  been  assigned  for  duty  at  Honolulu, 
Hawaii.  Dr.  Henry  Lee  Smith  is  at  Tobyhanna.  First  Lieutenant 
F.  K.  Nichols,  Associate  in  Physiology,  is  Medical  Officer  o*"  the  post 
at  Fort  Howard,  Md.  Major  Gideon  Van  Poole,  '99  is  at  Eagle 
Pass  and  Major  Jere  B.  Clayton,  '93  is  probably  at  Columbus,  New 
Mexico.  Major  W.  A.  Wickline  P.  &  S.,  '95  is  on  the  border.  Cap- 
tains Wm.  L.  Hart,  '04,  Taylor  E.  Darby,  '04  and  Jas.  S.  Fox,  '07 
are  with  the  regulars  on  the  border  or  in  Mexico. 

THE  STATE  APPROPRIATIONS  FOR  1915  AND  1916 

The  legislature  of  1914  appropriated  $15,000,  for  medical  educa- 
tion for  1915  and  a  similar  amount  for  1916,  but  owing  to  financial 
embarrassment  of  the  state  treasury  these  sums  were  not  paid  when 
due.     We  are  pleased  to  report  that  the  whole  amount,  $30,000 


EDITORIALS  49 

has  now  been  paid  and  is  a  most  welcome  addition  to  our  resources. 
The  last  legislature  appropriated  $25,000,  for  1917  and  a  like  sum 
for  1918,  so  we  shall  not  be  dependent  on  students  fees,  entirely,  for 
the  next  two  years.  By  these  appropriations  the  state  has  given 
concrete  evidence  of  its  belief  that  medical  teaching  is  a  part  of  the 
general  educational  system  and  as  such  must  be  fostered  by  the 
state.  The  day  of  the  unendowed  and  unsubsidised  medical  school 
is  over,  and  a  properly  conducted  medical  school  cannot  exist  on 
students'  fees  but  must  have  assistance  from  the  state  or  from  pri- 
vate benefactions.  These  appropriations  will  be  used  for  paying 
teachers  in  the  laboratory  branches  and  not  for  general  purposes. 
The  medical  classes  are  bound  to  be  smaller  than  formerly  owing  to 
the  rapid  increase  in  the  requirements  for  admission.  Our  last 
large  class  will  be  graduated  next  June  and  it  is  not  probable  that 
the  classes  will  average  more  than  sixty  members  in  each  for  some 
years  to  come.  The  assistance  of  the  state,  or  gifts  from  individu- 
als, will  therefore  be  necessary,  if  the  school  is  to  be  maintained. 
As  the  institution  is  a  necessity  for  the  state  of  Maryland  we  have 
faith  to  believe  that  the  requisite  funds  will  be  provided.  We  should 
not,  however,  depend  upon  the  largesses  of  the  state  exclusively  but 
should  make  strenuous  efforts  to  increase  our  endowment  funds.  It 
can  be  done  if  we  make  earnest  efforts  to  do  so. 

RESIGNATIONS  OF  PROFJESSORS  POLE  AND  NYDEGGER 

Dr.  Arminius  C.  Pole,  Professor  of  Descriptive  Anatomy,  pre- 
sented his  resignation  at  the  meeting  of  the  Faculty  held  on  Septem- 
ber 12,  1916.  He  graduated  at  the  University  of  Maryland  in 
1876  and  entered  on  the  practice  of  his  profession  in  this  city.  He 
soon  acquired  a  large  and  lucrative  practice  and  has  been  for  a 
long  time  one  of  the  prominent  physicians  of  the  city.  Many 
years  ago  he  was  elected  professor  of  anatomy  in  the  Baltimore 
Medical  College  and  he  continued  to  exercise  the  duties  of  that 
position  until  the  merger  of  that  institution  with  the  University  of 
Maryland  in  1913.  He  thereupon  became  professor  of  descriptive 
anatomy  in  the  University,  in  association  with  Professor  J.  Hohnes 
Smith.  From  long  service  he  has  earned  the  right  to  honorable 
retirement.  He  carries  with  him  the  best  wishes  of  his  colleagues 
for  a  long,  useful  and  happy  life. 

At  the  same  meeting  Dr.  James  A.  Nydegger  resigned  his  chair  of 


|^"""^"r'55;^v^  EDITORIALS 

c^'^'"  . '"'^''"^ 

.   .  —  ^Tropical  J^tjlicine.     Dr.  Nydegger  graduated  at  the  University  in 

18931^  the^ame  class  as  Dr.  Rupert  Blue,  Surgeon  General  of  the 

"'^Ij lifted  Statesi/Pubhc  Health  Service.     He  also  entered  this  service 

^y^o  ^^^^  has^i^in^ned  a  member  thereof  until  now.     Pie  has  been  sta- 

^'^  OFtioiiB^^^j^s  city  for  several  years  and  has  given  most  acceptable 

3S  on  the  diseases  incident  to  tropical  climates.     He  has  also 

brought  many  specialists  in  these  diseases  to  the  University,  who 

have  given  first  hand  instruction  in  these  important  subjects.     We 

regret  that  the  exigencies  of  the  service  require  Dr.  Nydegger  to 

sever  his  connection  with  the  school. 

THE  BANQUET 

The  first  joint  annual  banquet  of  the  alumni  and  graduates  was 
held  at  the  Hotel  Emerson,  May  31,  1916.  If  there  were  any 
misgivings  as  to  its  success,  these  dissipated  as  the  mist  before  the 
sun  as  the  loyal  sons  of  old  Maryland  began  to  arrive  in  groups  of 
twos,  threes,  and  mgre  long  before  the  hour  appointed  for  the  begin- 
ning of  festivities.  The  fates  must  have  joined  hands  to  make  the 
a^^air  a  never  to  be  forgotten  occasion.  Long  will  the  impression 
remain  indelibly  engraven  on  the  minds  of  those  present.  Success 
is  a  too  common-place  expression  to  use  to  describe  sach  an  auspici- 
ous moment  in  the  history  of  the  University  of  Maryland.  The 
idea  of  a- joint  banquet  was  indeed  a  happy  conception.  Some  of  us 
have  prayed  long  and  faithfully  for  the  dawning  of  the  day  when 
such  an  affair  would  be  possible.  Even,  now,  had  it  not  been  for 
the  indomitable  optimism  and  energy  of  Dr.  A.  H.  Carroll,  presi- 
dent of  the  Medical  Alumni  Association,  it  would  not  have  been 
possible.  Checked  here  and  there  by  what  some  with  less  de- 
termination would  have  considered  unsurmountable  barriers,  he 
kept  pegging  away  until  finally  the  last  obstacle  was  overcome  and 
the  banquet  was  an  assurance.  For  his  efforts  in  behalf  of  the  corn- 
summation  of  this  long  cherished  institution,  too  much  praise  can- 
not be  meted  out  to  Dr.  Carroll.  The  sight  of  more  then  500 
guests  seated  at  the  festive  board  must  have  been  extremely  grati- 
fying to  Dr.  Carroll  and  his  associates  on  the  committee  who 
had  the  arrangements  in  hand.  Not  the  least  pleasant  feature 
of  the  evening  was  the  spirit  of  fraternity,  harmony  and  university 
spirit  displaj^ed  by  our  most  recent  associations.  These  men  entered 
into   the   affair  with  the  same  enthusiasm  as  the  graduates  of  the 


EDITORIALS  51 

University  of  Maryland  proper.  The  old  guard  and  the  new  vied 
with  each  other  in  making  the  banquet  a  roaring  success.  Surely 
the  occasion,  as  no  other,  firmly  cemented  us  in  the  bonds  of  educa- 
tional matrimony.  It  marked  the  passing  of  the  old  University  of 
Maryland  and  the  birth  of  a  new  and  better  University  of  Mary- 
land. Then  as  never  before  did  the  graduates  of  the  Baltimore  Medi- 
cal College,  those  of  The  College  of  Physicians  and  Surgeons  and  the 
University  of  Maryland  come  to  a  thorough  realization  that  we  are 
part  and  parcel  of  a  great  institution  of  learning,  full  of  dynamic 
and  potential  possibilities.  Surely  none  of  our  older  graduates  in 
their  wildest  dreams  ever  dreamt  that  they  would  witness  such  a 
memorable  event  in  the  history  of  the  University  of  Maryland. 
It  was  indeed  a  compliment  to  the  institution  that  such  men  as 
Dr.  Henry  L.  Naylor,  class  of  1860,  nearly  80  years  of  age; 
Charles  R.  Winterson,  class  of  1871;  C.  E.  Sadtler,  class  of  1873; 
John  L.  Pennington,  class  of  1869;  now  no  longer  young  did  us  the 
honor  of  being  present.  The  presence  of  these  and  others  too 
numerous  to  mention,  equally  as  full  of  years  and  honors  augurs 
well  for  our  future.  Our  younger  graduates  may  indeed  take  heart 
and  be  assured  of  our  continued  usefulness  after  a  demonstration 
of  this  character.  And  now,  at  the  expense  of  possible  iteration 
The  Bulletin  of  the  University  of  Maryland  School  of 
Medicine  and  The  College  of  Physicians  and  Surgeons 
thanks  the  graduates  of  the  University  of  Maryland,  of  the  Balti- 
more Medical  College  and  the  College  of  Physicians  and  Surgeons, 
and  Dr.  Albert  H.  Carroll  and  his  committee  and  the  speakers 
for  their  part  in  making  the  event  the  success  it  was.  To  the 
speakers  and  the  toast-master  belong  much  credit  for  making  the 
evening  pleasant,  memorable  and  profitable.  The  Bulletin  ex- 
tends to  these  gentlemen  on  behalf  of  the  alumni  its  thanks  for 
the  part  they  took.  Messrs.  Fell,  Bonaparte,  Simmons,  Ritchie, 
Hodson,  Dawkins,  Winslow,  yours  was  no  small  part  in  the  success 
of  the  gathering.  Your  interest  gives  us  stouter  hearts  to  tackle 
the  problems  confronting  us.  You  and  the  gentlemen  present  indi- 
cate the  desire  of  the  alumni  to  meet  annually  as  a  unit  rather  than 
as  individual  schools;  you  have  awakened  in  us  a  pride  in  our 
institution,  you  have  attested  the  creation  of  a  University  of 
Maryland  in  fact  as  well  as  name.  Now  that  there  has  been  a 
joint  banquet,  let  it  become  an  annual  custom. 


52  EDITORIALS 

LOSSES  IN  THE  FACULTY 

Since  our  June  issue  the  Faculty  has  been  called  on  to  mourn  the 
loss  of  two  of  its  most  distinguished  members.  Prof.  Thomas  A. 
Ashby  died  on  June  26,  1916,  after  a  lingering  illness,  and  Prof. 
William  Simon  succumbed  on  July  19,  also  after  a  prolonged  period 
of  poor  health. 

The  death  of  Dr.  Ashby  was  not  unexpected  as  he  had  been  con- 
fined to  the  house  practically  since  the  middle  of  November,  and 
had  only  held  his  classes  during  the  first  few  weeks  of  the  last  ses- 
sion. He  had  been  professor  of  diseases  of  women  in  the  University 
for  nearly  19  years  and  was  thoroughly  identified  with  the  institu- 
tion. He  was  an  extremely  dextrous  operator,  a  facile  writer,  and 
a  most  accomplished  gentlemen. 

Dr.  Wm.  Simon  was  born  in  Germany  and  was  trained  in  the 
thorough  manner  of  that  country.  He  came  to  America  while  a 
young  man  and  soon  became  professor  of  chemistry  in  the  Maryland 
College  of  Pharmacy,  now  the  Department  of  Pharmacy  of  the  Uni- 
versity of  Maryland.  He  was  professor  of  chemistry  in  the  Col- 
lege of  Physicians  and  Surgeons  during  its  whole  separate  existence 
and  became  professor  of  chemistry  in  the  University  on  the  merger 
of  the  two  schools.  He  was  a  man  of  high  scientific  attainments  and 
of  wide  distinction  and,  withal,  was  a  lovable  and  friendly  person. 

MEETING  OF  THE  NEW  ENGLAND  ALUMNI 

The  University  is  fortunate  in  having  in  New  England  a  remark- 
ably spirited  and  enterprising  organization  of  alumni.  The  society 
was  founded  about  twelve  years  ago  by  alumni  of  the  then  Balti- 
more Medical  College  and  latterly  with  the  consolidation  of  our 
schools  it  has  been  largely  augumented  by  the  graduates  of  the 
old  University  of  Maryland  and  of  the  College  of  Physicians  and 
Surgeons. 

At  the  eleventh  annual  meeting  and  banquet  held  in  Young's 
Hotel  in  Boston  on  the  6th  of  June  last,  representatives  of  all  these 
schools  were  present.  The  occasion  was  an  interesting  and  enjoy- 
able one.  Practitioners  from  all  the  New  England  states  attended 
and  the  men  gathered  at  the  banquet  were  quite  obviously  success- 
ful and  important  members  of  their  calling.  The  retiring  president, 
Dr.  A.  Lawrence  Miner  of  Bellows  Falls,  Vt.,  presided  and  was 
toastmaster  and   the  newly   elected   president,    our   distinguished 


i 


EDITORIALS  53 

alumnus  and  former  Baltimorean,  Dr.  Wm.  T.  Councilman,  Pro- 
fessor of  Pathology  in  Harvard  made  an  admirable  address.  Speeches 
were  also  made  by  Dr.  Edward  C.  Conroy  of  Andover,  Mass.,  who 
paid  a  glowing  tribute  to  the  late  Dr.  Streett;  by  Dr.  T.  G.  Dough- 
erty of  Somersworth,  N.  H.;  Dr.  H.  J.  Keaney  of  Everett,  Mass.; 
Dr.  C.  B.  O'Rourke  of  Providence,  R.  I.;  Dr.  J.  H.  Judkins  of  North- 
field,  Mass.;  Dr.  F.  M.  Dunn  of  New  London,  Conn.,  and  others. 
The  faculty  was  represented  by  Dr.  R.  B.  Warfield,  who  spoke  of 
the  satisfactory  inauguration  of  the  new  conditions,  of  its  large 
f.eld  of  usefulness  and  the  abundant  promises  of  the  future.  The 
secretary  of  the  association.  Dr.  Charles  S.  Oilman  of  Boston  and  the 
treasurer,  Dr.  A.  K.  Yoosuf  of  Worcester  are  both  indefatigable 
workers  toward  the  maintenance  and  development  of  the  alumni 
organization. 

MEETING  OF  THE  NEW  YORK  ALUMNI 

The  New  York  Alumni  of  the  merged  schools  met  at  Skaneateles 
August  3L  Skaneateles  is  a  small  but  very  attractive  town  on 
the  shore  of  Lake  Skaneateles,  which  is  situated  in  the  northern 
part  of  the  state  of  New  York,  eighteen  miles  from  Syracuse.  Lake 
Skaneateles  is  a  beautiful  body  of  water  about  sixteen  miles  in 
length.  Its  water  is  very  clear  and  of  a  beautiful  greenish  blue 
color,  and  very  much  resembles  the  lakes  of  Switzerland.  Its  shores 
are  rolling,  hilly,  partially  woody  and  partially  under  cultivation, 
and  the  entire  shore  line  is  dotted  with  summer  cottages. 

Thirty  graduates  of  the  Baltimore  Medical  College,  University  of 
Maryland,  and  College  of  Physicians  and  Surgeons,  attended  the  meet- 
ing. The  majority  of  those  in  attendance  were  from  the  Baltimore 
Medical  College,  but  there  were  quite  a  number  of  alumni  of  the 
other  schools.  Most  of  the  men  who  attended  brought  their  wives 
along,  and  the  afternoon  was  spent  on  Lake  Skaneateles,  in  an  ex- 
cursion sixteen  miles  up  the  lake  and  back.  This  was  a  very  de- 
hghtful  trip.  The  day  was  a  beautiful  one,  and  if  the  31st  of  August 
was  a  fair  sample  of  Skaneateles  weather,  it  justly  deserves  its 
fame  as  a  resort.  Dr.  George  E.  Clark,  University  of  Maryland 
1889,  located  at  Skaneateles,  was  chairman  of  the  Arrangement 
Committee,  and  the  arrangements  for  the  reception  and  entertain- 
ment of  the  men  were  most  excellent.  Dr.  Clark  was  very  much 
disturbed  and  very  anxious  because  the  poliomyelitis  scare  had 
just  reached  Skaneateles  that  day,  and  he  was  being  called  here 
and  there  by  distracted  parents,  and  had  a  very  harassing  day. 


54  EDITORIALS 

After  the  trip  on  the  lake  and  back,  a  meeting  was  held  at  which 
the  following  business  was  transacted:  President  for  the  ensuing 
year,  F.  E.  Fox,  241  Cayuga  Street,  Fulton,  N.  Y.;  Vice-President, 
A.  B.  Miller,  326  Montgomery  Street,  Syracuse,  N.  Y,,  Secretary 
and  Treasurer,  Louis  Wheeler,  W.  Main  Street,  Tully,  N.  Y.  Presi- 
dent Fox  has  appointed  the  following  committees:  New  Constitu- 
tion and  By-Laws,  Drs.  R.  J.  McFarland,  A.  B  Miller,  and  J.  T. 
Hennessey,  all  of  Syracuse,  N.  Y.;  David  Streett  Scholarship  Memo- 
rial Fund,  Drs.  Milton  E.  Gregg,  Elbridge,  N.  Y.,  A.  B.  Morse, 
Oxford,  N.  Y.,  E.  W.  Carr,  Lyons,  N.  Y.,  E.  G.  MacFarland,  Clin- 
ton, N.  Y.,  and  F.  J.  Schwartz,  Spring  Valley,  N.  Y.  After  the 
business  meeting  a  very  delightful  dinner  was  served  at  Kreb's. 
Mrs.  Clark  and  Miss  Clark  had  thoroughly  canvassed  the  entire 
community  and  had  gathered  as  decorations  for  the  table  a  large 
number  of  medicinal  plants,  which  added  a  very  unique  feature  to 
the  occasion.  After  dinner,  a  number  of  addresses  were  made.  Dr. 
A.  B.  Miller,  University  of  Maryland  1882,  Syracuse,  N.  Y.,  whose 
association  with  the  New  York  State  Examining  Board  and  Syra- 
cuse University,  has  made  him  thoroughly  familiar  with  medical 
education,  spoke  on  the  ''Progress  of  Medical  Education  in  the 
United  States."  He  called  attention  to  the  rapid  elimination  of 
medical  schools,  to  the  advancement  in  premedical  requirements, 
and  to  the  changes  in  the  state  board  requirements.  He  also  ex- 
plained the  changes  in  medical  education  brought  about  b}^  the 
Council  on  Education  of  the  American  Medical  Association,  by 
the  Association  of  American  Medical  Colleges,  and  by  the  differ- 
ent state  boards.  This  address  was  very  clear  and  instructive, 
and  was  thoroughly  enjoyed.  Dr.  M.  E.  Gregg,  Baltimore  Medi- 
cal College  1896,  Elbridge,  N.  Y.,  spoke  of  the  late  Dr.  David  Streett. 
His  address  was  a  very  beautiful  one;  and  he  paid  a  just  and  glow- 
ing tribute  to  Dr.  Streett's  work  in  the  Baltimore  Medical  College, 
as  organizer,  teacher,  and  dean.  He  paid  special  attention  to  Dr. 
Streett's  character  and  influence  as  a  man. 

Dr.  Shipley,  who  attended  the  meeting  as  the  school  representa- 
tive, spoke  of  the  merged  schools,  of  the  conditions  which  led  up 
to  the  merger  and  made  it  necessary,  and  explained  the  details  of 
the  merger. 

The  following  alumni  were  present: 

A.  R.  Morse,  Baltimore  Medical  College  1904,  Oxford,  N.  Y. 
Bernard  Levinson,  Baltimore  Medical  College  1908,  Newburgh,  N.  Y. 


EDITORIALS  55 

Frank  J.  Schwartz,  Baltimore  Medical  College  1907,  Spring  Valley,  N.  Y. 

W.  A.  Vincent,  College  of  Physicians  and  Surgeons  1882,  Three  Mile  Bay,  N.  Y. 

H.  L.  Vincent, 

P.  S.  Cripps,  Baltimon-e  Medical  College  1907,  Buffalo,  N.  Y. 

M.  E.  Proctor,  Baltimore  Medical  College  1907,  Lake  Placid,  N.  Y. 

Charles  F.  Yerdon,  Baltimore  Medical  College  1897,  Brooklyn,  N.  Y. 

M.  E.  Gregg,  Baltimore  Medical  College  1896,  Elbridge,  N.  Y. 

E.  W.  Carr,  Baltimore  Medical  College  1902,  Lyons,  N.  Y. 

F.  E.  Fox,  Baltimore  Medical  College  1901,  Fulton,  N.  Y. 

W.  J.  K.  McFarland,  Baltimore  Medical  College  1897,  Syracuse,  N.  Y. 
Walter  W.  Osgood,  Baltimore  Medical  College  1902,  Jordan,  N.  Y. 

G.  C.  Reid,  Baltimore  Medical  College  1902,  Rome,  N.  Y. 

H.  D.  McFarland,  Baltimore  Medical  College  1910,  Westernville,  N.  Y. 

A.  B.  Miller,  LTniversity  of  Maryland  1882,  Syracuse,  N.  Y. 

W.  P.  Miller,  University  of  Maryland  1917,  Syracuse,  N.  Y. 

J.  E.  Andrews,  College  of  Physicians  and  Surgeons  1894,  Fabius,  N.  Y.. 

W.  S.  Wescott,  Buffalo,  N.  Y. 

J.  T.  Hennessey,  University  of  Maryland  1916,  Syracuse,  N.  Y. 

Louis  Wheeler,  Baltimore  Medical  College  1901,  Tully,  N.  Y. 

Harry  M.  Biffar,  College  of  Physicians  and  Surgeons  1912,  College  Point,  N.  Y. 

E.  H.  Wakelee,  University  of  Maryland  1884,  Big  Flats,  N.  Y. 

W.  P.  Kanar,  College  of  Physicians  and  Surgeons  1893,  Salvay,  N.  Y. 

L.  C.  Stuart,  College  of  Physicians  and  Surgeons  1938,  Rome,  N.  Y. 

S.  D.  Sawyer,  Baltimore  Medical  College,  1938,  Mecklenburg,  N.  Y. 

A.  W.  Stiles,  Baltimore  Medical  College  1897,  Oswego,  N.  Y. 

E.  G.  MacFarland,  Baltimore  Medical  College  190S,  Clinton,  N.  Y. 

Frank  Dye,  University  of  Maryland  1919,  Elbridge,  N.  Y. 

George  E.  Clark,  University  of  Maryland  18S9,  Skaneateles,  N.  Y. 

RESCUES  YOUNG  MAN 

"I  will  tell  you  the  strangest  experience  of  my  life  in  Baltimore,"  said 
Dr.  Jones,  and  he  told  this  story  with  all  the  effectiveness  of  the  born  orator: 

"Some  years  ago  I  was  walking  down  Broadway  with  Mrs.  Jones  and  I 
saw  a  remarkably  nice-looking  young  man  of  20  or  22  doing  menial  work. 

"  'Young  man,'  I  said,  'why  are  you  doing  this  sort  of  work?  You  look 
capable  of  something  better.  Was  it  all  you  could  find  to  do?'  And  he 
said  it  was. 

"So  I  told  him  that  if  he  would  come  to  me  I  would  try  to  find  some  better 
work  for  him.  I  had  noticed  at  once  that  his  face  bore  the  stamp  of  unusual 
intelligence  and  that  he  spoke  with  an  educated  English  accent. 

"He  came  home  with  us  and  I  found  that  he  had  a  remarkable  talent  for 
drawing  and  that  he  wished  to  become  a  physician.  To  make  a  long  story 
short,  he  helped  himself  through  the  University  of  Maryland  by  drawing 
anatomical  charts,  took  all  sorts  of  honors,  graduated  first  in  his  class.  Even- 
tually he  went  back  to  England  and  now  he  has  a  long  string  of  letters  after 
his  name  and  is  one  of  the  most  prominent  physicians  in  the  country." 

"But  why  did  he  come  to  Baltimore?" 


56  ITEMS 

"It  was  all  on  account  of  a  love  affair,"  chuckled  Dr.  Jones.  "He  fell  in 
love  with  a  nobleman's  daughter.  The  nobleman  told  him  that  he  would 
have  to  show  that  he  was  worth  something  before  he  could  have  her,  so  he 
came  to  America  to  make  his  fortune,  and  that's  why  I  found  him  when  I  did. 

"Not  very  long  ago  he  was  married  and  he  wrote  begging  me  to  come  to 
England  and  asking  me  to  accept  the  passage  from  him,  but  I  couldn't  do  so." 

This  statement  above,  extracted  from  an  article  by  the  Rev.  J. 
Wynne  Jones  in  the  Baltimore  Sun  of  October  8,  1916,  evidently 
refers  to  Dr.  J.  Ridley  Nott,  a  young  Englishman  who  graduated 
with  first  honors  in  1886  and  who  subsequently  served  as  Assistant 
Resident  Physician  in  the  University  Hospital  in  1886-87.  Noth- 
ing had  been  heard  of  him  at  the  University  for  many  years,  and 
we  are  delighted  to  have  this  information  concerning  his  subsequent 
career. 

ITEMS 

The  following  graduates  of  the  University  of  Maryland  School  of 
Medicine  and  College  of  Physicians  and  Surgeons  having  passed 
successful  examinations  were  licensed  to  practice  in  Maryland  by 
the  Board  of  Medical  Examiners. 

Richard  T.  Arnest  Frank  C.  Marino 

Bartus  T.  Baggott  •  Henry  A.  Merkel 

George  A.  Bawden  Milfert  W.  Myers 

Edward  H.  Benson  Joseph  G.  O'Brien 

Charles  R.  Brooke  Vincent  J.  Oddo 

Benjamin  B.  Brumbaugh  Wm.  F.  O'Malley 

Henry  F.  J.  Buettner  Adam  W.  Reier 

Charles  H.  Burton  Charles  A.  Reifschneider 

John  E.  Evans  Frederick  Ruzicka 

Bernard  J.  Ferry  Samuel  Snyder 

Bernard  S.  Jacobson  Edward  P.  Thomas 

Benjamin  M.  Jaffe  Norwood  W.  Voss 

Bernard  R.  Kelly  William  F.  Williams 
Allen  D.  Lazenby 

We  are  glad  to  announce  that  all  the  University  of  Maryland 
men  who  took  the  state  board  examination  in  North  and  South 
Carolina  were  successful  in  passing  them  and  have  received  their 
Hcenses.  We  regret  that  we  have  not  been  able  to  secure  their 
names. 


ITEMS  67 

Dr.  Albert  H.  Carroll,  class  of  1907  U.  of  M.,  Associate  Professor 
of  Gastro-enterology,  has  been  spending  his  vacation  at  Chester, 
Nova  Scotia,  where  there  is  quite  a  colony  of  Baltimoreans.  He 
comments  on  the  health  giving  qualities  of  the  location  which  judged 
from  the  picture  postal  sent,  must  be  remarkably  beautiful. 

Dr.  Thomas  F.  Keating,  P.  &  S.  1910,  U.  S.  Pubhc  Health  Service, 
is  now  on  duty  at  Manila,  P.  I. 

Dr.  J.  Hubert  Wade,  B,  M.  C.  '95  was  made  Chairman  of  the 
State  Democratic  Committee. 

Dr.  Samuel  H.  Allen,  a  prominent  surgeon  of  Salt  Lake  City, 
Utah  and  graduate  of  College  of  Physicians  and  Surgeons,  1890, 
spent  the  months  of  June  and  July  doing  post-graduate  work  in 
Genito-Urinary  Surgery,  under  Dr.  A.  G.  Rytina.  While  in  Balti- 
more he  was  a  guest  of  Dr.  Wm.  S.  Gardner. 

Dr.  W.  G.  Harper,  class  of  1910,  College  of  Physicians  and  Sur- 
geons, now  located  at  Beverly,  W.  Va.,  spent  a  few  days  visiting 
Mercy  Hospital. 

Dr.  Ray  M.  Bobbitt  of  Hinton,  W.  Va.,  P.  &  S.,  1913,  took  a 
special  course  in  Genito-Urinary  Surgery  under  Dr.  A.  G.  Rytina 
and  in  Gynecological  Pathology  under  Dr.  Wm.  S.  Gardner.  He 
will  confine  his  work  in  Ganito-Urinary  Surgery  and  Laboratory 
work  in  Hinton. 

Dr.  Frank  M.  Moose,  for  three  years  resident  surgeon  of  the 
Mercy  Hospital,  spent  two  months  doing  special  work  in  Genito- 
Urinary  Surgery  under  Dr.  A.  G.  Rytina  at  the  Mercy  Hospital. 
He  will  specialize  in  Genito-Urinary  Surgery  in  Dallas,  Texas. 

Miss  Florence  Kennedy,  an  Alumna  of  Mercy  Hospital  Training 
School,  1915,  who  has  been  doing  private  nursing  in  the  city  since 
her  graduation,  recently  joined  the  Red  Cross  service  and  was  sent 
to  Eagle  Pass,  Texas,  September  14,  1916. 

Dr.  Richard  Shea,  P.  &  S.  1914,  who  has  been  assistant  in  Dr. 
McGlannan's  office  has  returned  to  the  Mercy  Hospital  as  resident 
surgeon  on  Dr.  McGlannan's  service. 


58  ITEMS 

Dr.  F.  X.  Kearney,  P.  &  S.  1915,  who  was  assistant  resident  sur- 
geon on  Dr.  McGlannan's  service  at  the  Mercy  Hospital  during  the 
past  year  is  now  office  assistant,  succeeding  Dr.  Shea. 

At  a  recent  meeting  of  the  Faculty  of  Physic  it  was  decided  that 
beginning  with  the  next  session  the  senior  class  will  be  divided  into 
trimesters  instead  of  the  usual  semesters.  The  students  will  be 
required  to  spend  one-third  of  their  time  in  the  University  Hospital, 
one-third  in  the  Mercy  Hospital,  and  one-third  in  the  Maryland 
General  Hospital.  While  at  the  University  Hospital  the  senior 
students  will  live  in  the  hospital  itself  and  be  assistants  in  cUnical 
work. 

At  the  same  meeting  the  question  of  admitting  women  as  students 
on  an  equal  footing  with  men,  or  on  any  footing,  in  the  medical 
department  was  discussed,  but  action  was  deferred  until  the  next 
meeting.     Many  of  the  members  are  in  favor  of  the  movement. 

Dr.  E.  M.  Parlett,  B.M.C.,  class  of  1902,  formerly  of  Baltimore, 
Md.,  until  recently  company  physician  at  New  Castle,  Pa.,  has  been 
made  chief  of  the  bureau  of  welfare  of  the  Baltimore  and  Ohio 
Railroad,  reporting  to  J.  T.  Broderick,  supervisor  of  special  bureaus. 

Dr.  Parlett  has  been  connected  with  the  relief  department  of 
the  Baltimore  and  Ohio  for  a  number  of  years  as  resident  physician 
in  various  cities  and  was  also  sanitation  expert  on  the  general  safety 
committee,  of  which  the  late  Major  J.  G.  Pangborn  was  the  chairman, 
being  especially  qualified  as  sanitarian  on  account  of  special  courses 
taken  in  this  modern  branch  of  medical  science  at  the  University  of 
Maryland.  He  brings  to  his  work  not  only  splendid  professional 
abihty,  but  a  likable  personality,  which  will  be  of  great  value  to 
him  in  his  new  and  important  work.  His  long  experience  in  the 
relief  department  and  the  invaluable  knowledge  of  conditions  on 
the  system  which  he  secured  while  a  member  of  the  general  safety 
committee  have  given  him  a  fine  understanding  of  the  company's 
welfare  problems,  the  study  and  solution  of  which  he  will  immedi- 
ately begin. 

Dr.  Parlett  has  our  heartiest  congratulations. 

Dr.  E.  L.  Whitney,  associate  professor  of  Physiological  Chemistry, 
Pharmacology  and  Chnical  Pathology,  has  tendered  his  resignation. 
He  will  leave  shortly  for  Portland,  Oregon. 


ITEMS  59 

On  May  12,  Dr.  Thomas  E.  Latimer,  class  of  1907,  and  Mrs. 
Latimer,  of  Hyattsville,  Md.,  entertained  several  members  of  the 
class  of  1907  as  follows:  Drs.  Edgar  Perkins  and  Frank  S.Lynn,  of 
Baltimore,  Md.;  J.  Burr  Piggott,  of  Washington,  D.  C;  Thomas 
H.  Legg,  of  Union  Bridge,  Md.,  and  Jacob  W.  Bird,  of  Sandy  Spring, 
Md. 

These  members  of  the  class  of  1916  have  accepted  appointments 
in  the  following  hospitals  in  and  around  Baltimore: 

Maryland  General  Hospital. — H.  Goldman,  B,  M.  Jaffe,  B.  H. 
Lovely,  J.  J.  Roberts,  B.  H.  Growt,  G.  A.  Bawden,  W.  H.  Sloan. 

Mercy  Hospital— B.  M.  Aikman,  B.  T.  Baggott,  I.  P.  A.  Byrne, 
L.  R.  Chaput,  L.  H.  Howard,  Geo.  McLean,  A.  F.  Peterson,  G.  R. 
Post,  E.  F.  Syrop,  H.  D.  Wolfe. 

Municipal  Hospital. — Adam  W.  Reier,  Benjamin  B.  Brumbaugh, 
James  C.  Cudd,  A.B.,  Percival  R.  Bennett,  Samuel  0.  Pruitt,  A.B., 
James  J.  Chandler,  A.B. 

*S^.  Agnes'  Hospital. — E.  P.  Dunne,  Allen  D.  Lazenby,  H.  W. 
Rogers. 

St.  Joseph's  Hospital. — R.  T.  Arnest,  H.  A.  Merkel,  R.  L.  Hanigan, 
W.  T.  O'Malley,  H.  W.  Gwynn. 

University  Hospital. — Frank  C.  Marino,  Charles  A.  Reifschneider, 
Robert  H.  Folk,  A.B.,  John  E.  Evans,  A.B.,  Michael  E.  Cavello, 
Richard  T.  Arnest,  WilHe  T.  Ferneyhough,  Clark  S.  Long,  Thomas 
L.  Bray. 

Woman's  Hospital. — Charles  R,  Brooke,  Maurice  C.  Wentz,  B.S., 
Cecil  Rigby,  B.S. 

Dr.  Humphrey  W.  Butler,  class  of  1913,  who  has  been  practicing 
in  Brazil,  S.  A.,  for  the  past  three  years,  has  returned  to  Baltimore, 
where  he  will  locate.  He  will  confine  his  practice  to  eye,  ear,  nose, 
and  throat  work.    He  was  a  recent  visitor  to  the  University  Hospital. 

Dr.  Earle  G.  Breeding,  class  of  1913,  formerly  attending  physician 
to  the  Atlantic  Coast  Line  Railroad,  stationed  at  Rocky  Mount, 
N.  C,  has  tendered  his  resignation  and  has  accepted  the  position 
of  chief  resident  physician  to  the  Episcopal  Eye,  Ear,  Nose,  and 
Throat  Hospital,  Washington,  D.  C. 

Dr.  Roy  Robinson  Kerkow,  class  of  1915,  is  located  at  Addy, 
Washington. 


60  ITEMS 

On  the  evening  of  May  12  the  class  of  1917,  University  Hospital 
Training  School  for  Nurses,  entertained  the  graduating  class  in  the 
Nurses'  Home.  Supper  was  served  in  the  nurses'  dining  room  and  a 
most  delightful  evening  spent  in  dancing.  Dr.  Coleman  allowed  the 
residents  of  the  hospital  to  attend. 

Mrs.  H.  E.  Knorr,  Superintendent  of  Nurses  of  the  Tubercular 
Division,  Public  Health  Department,  gave  a  very  interesting  talk 
on  the  requirements  and  opportunities  in  public  health  nursing  to 
the  graduating  class  on  the  afternoon  of  May  14. 

At  a  recent  meeting  of  the  Faculty  of  Physic  the  resignation  of 
Dr.  William  F.  Lockwood  as  dean  of  the  medical  school  was  accepted, 
and  Dr.  J.  M.  H.  Rowland  was  elected  dean  to  succeed  him.  Other 
officers  elected  were:  President,  Randolph  Winslow,  M.D;  vice- 
president,  John  W.  Chambers,  M.D.;  secretary,  William  S.  Gardner, 
M.D.;  treasurer,  Samuel  K.  Merrick,  M.D.;  executive  committee, 
Drs.  Ridgely  B.  Warfield,  Arthur  M.  Shipley,  Harry  Friedenwald, 
Gordon  Wilson,  Standish  McCleary  and  J.  M.  H.  Rowland. 

At  the  recent  meeting  of  the  North  Carolina  State  Medical  Society, 
Dr.  Ernest  S.  Bullock,  class  of  1911,  was  appointed  a  member  of  the 
Board  of  Councilors. 

Dr.  Charles  A.  Reifschneider,  who  was  lately  appointed  assistant 
to  Dr.  Page  Edmunds,  is  also  assisting  Dr.  Frank  Martin  and 
Dr.  Robert  Bay  at  the  University  Hospital. 

Dr.  H.  P\.Stein  was  acting  superintendent  of  the  University  Hos- 
pital during  the  absence  of  Dr.  W.  J.  Colemann,  who  is  a  captain 
in  the  Fourth  Regiment,  I.  M.  N.  G.,  lately  stationed  in  Texas. 

Dr.  R.  G.  Willse  of  the  gynecological  outpatient  department  has 
been  recently  appointed  a  member  of  the  gynecological  staff  at  the 
Hebrew  Hospital. 

Dr.  J.  W.  Pierson,  1905,  now  medical  director  of  the  health  and 
accident  department  of  the  Fidelity  and  Deposit  Co.,  has  been  ap- 
pointed assistant  in  rontgenology  at  Johns  Hopldns  Hospital. 

The  Baltimore  County  Medical  Association  was  entertained  at 
Sparrows  Point  by  Dr.  Frank  Coral  Eldred  and  Dr.  George  Carville 
McCormick.  A  number  of  prominent  physicians  and  surgeons  were 
in  attendance. 


DEATHS  61 

Dr.  P.  P.  Vinson  of  the  University  of  Maryland  has  received  an 
appointment  at  the  Mayo  chnic  in  Rochester  and  will  go  there  on 
September  1.     Dr.  Vinson  will  work  in  pathology  and  medicine. 

The  death  of  Dr.  Ashby  made  a  vacancy  in  the  gynecological 
service  in  the  University  Hospital.  This  has  been  filled  by  the  ap- 
pointment of  Dr.  Hugh  Brent  in  collaboration  with  Dr.  J.  Mason 
Hundley.  Dr.  Brent  graduated  in  1903  and  has  been  connected 
with  the  gynecological  department  since  that  time.  He  is  a  young 
man  of  fine  ability  and  of  excellent  attainments  and  we  prognosti- 
cate a  very  successful  career  for  him. 

DEATHS 

Dr.  Elijah  Miller  Reid,  U.  of  M.,  '64,  died  on  September  12,  1916, 
at  his  residence  904  N.  Fremont  Avenue,  of  apoplexy,  aged  61  years. 
He  was  a  well  known  physician  in  this  city  for  nearly  a  half  cen- 
tury and  at  one  time  was  professor  of  nervous  diseases  in  the  Bal- 
timore University. 

Dr.  John  Evelyn  Page,  Santa  Barbara,  Calif.,  U.  of  M.,  '89,  aged 
49,  surgeon  (lieutenant  commander),  U.  S.  Navy  (retired);  who 
entered  the  Navy  June  18,  1890,  and  was  retired  on  account  of  in- 
capacity resulting  from  an  incident  of  service,  April  3,  1908  after 
seven  years  and  eleven  months'  sea  service  and  six  years  and  eight 
months'  shore  or  other  duty,  died  May  28. 

Dr.  Geo.  Henry  Carpenter,  Cumberland,  Md.,  U.  of  M.,  1868, 
aged  73,  died  in  the  Allegany  Hospital  of  the  Sisters  of  Charity, 
Cumberland,  May  24. 

Dr.  John  C.  Knauer,  Reading,  Pa.,  C.  P.  &  S.,  '86,  aged  52,  died 
in  the  Homeopathic  Hospital,  Reading,  June  3,  from  septicemia  due 
to  an  operation  wound. 

Dr.  Edgar  J.  Spratling,  Atlanta,  Ga.,  C.  P.  &  S.,  '91,  a  member  of 
the  Medical  Association  of  Georgia;  a  member  of  the  staff  cf  the 
State  Hospital  for  Epileptics,  Palmer,  Mass.,  from  1898  to  1900,  and 
of  the  staff  of  the  Matteawan  State  Hospital,  Matteawan,  N.  Y., 
from  1904  to  1908;  medical  director  of  the  Empire  Life  Insurance 
Company,  Atlanta;  captain  of  "F"  company.  Fifth  Infantry,  Geor- 
gia, N.  G.;  was  shot  and  killed  by  an  insane  wonaan  at  the  state 
mobilization  camp  in  Macon,  Ga.,  August  25. 


62  DEATHS 

Dr.  Robert  J.  Gilliland,  Easley,  S.  C,  U.  of  M.,  '83,  aged  55,  for- 
merly a  Fellow  of  the  American  Medical  Association ;  a  member  of 
the  South  Carolina  Medical  Association;  died  at  his  home  June  25, 
from  cerebral  hemorrhage. 

Dr.  Charles  Frederick  Nolen,  Baltimore,  U.  of  M.,  '90,  aged  47,  a 
Fellow  of  the  American  Medical  Association ;  well  known  as  a  special- 
ist in  diseases  of  the  eye,  ear  and  throat;  ophthalmic  surgeon  to  the 
Baltimore  and  Ohio  System  and  assistant  surgeon  to  the  Presby- 
terian Eye  and  Ear  Hospital,  Baltimore,  Md.,  died  June  30. 

Dr.  Jacob  Hartman,  Baltimore,  U.  of  M.,  '69,  aged  69,  a  Fellow 
of  the  American  Medical  Association  and  vice  president  of  the 
American  Laryngological  Association  in  1883  and  1890;  a  specialist 
in  diseases  of  the  ear,  nose  and  throat;  surgeon  to  the  Baltimore 
Eye,  Ear  and  Throat  Charity  Hospital;  lecturer  on  diseases  of  the 
throat  and  chest  in  Washington  University  from  1874  to  1877; 
consulting  surgeon  to  the  Baltimore  Hospital  for  Consumptives; 
died  in  Mercy  Hospital,  Baltimore,  July  28. 

Dr.  Otho  C.  Wright,  Jarratt,  Va.,  C.  P.  &  S.,  '93,  aged  48,  a  Fellow 
of  the  American  Medical  Association;  a  member  of  the  State  Board 
of  Medical  Examiners  and  State  Board  of  Health  and  once  president 
of  the  Medical  Society  of  Virginia;  while  driving  his  automobile 
over  a  grade  crossing  at  Owen's  Store,  July  8,  was  struck  by  an 
Atlantic  Coast  Line  freight  train  and  instantly  killed. 

Dr.  James  D.  Weaver,  Eatonton,  Ga,  C.  P.  &  S.,  '82,  aged  58,  a 
member  of  the  Medical  Association  of  Georgia;  a  member  of  the 
state  board  of  health ;  who  was  run  over  by  an  automobile  in  Eaton- 
ton,  August  4,  died  a  day  later  as  a  result  of  his  injuries. 

Dr.  James  Edward  Leary,  Lowell,  Mass.,  C.  P.  &  S.,  '94,  aged  42, 
formerly  a  member  of  the  Massachusetts  Medical  Society;  died  at 
his  home  June  11,  from  heart  disease. 

Dr.  S.  P.  Watson,  Laris,  S.  C,  C.  P.  &  S.,  '84,  aged  54,  formerly  a 
member  of  the  South  Carolina  Medical  Association,  died  at  his 
home,  August  14. 

Dr.  Andrew  Jacob  Koontz,  Independence,  Va.,  C.  P.  &  S.,  '87,  aged 
57,  a  practitioner  and  druggist,  died  at  his  home,  June  20,  from 
heart  disease. 


BOOK   REVIEWS  63 

Dr.  Wm.  Thackery  Cathell,  Baltimore,  C.  P.  &  S.,  '86,  aged  52,  a 
member  of  the  Medical  and  Chirurgical  Faulty  of  Marj'land  and  a 
specialist  on  diseases  of  the  nose  and  throat ;  demonstrator  of  anat- 
omy, Baltimore  Medical  College;  died  in  the  Hotel  Emerson,  Bal- 
timore, August  24,  from  nephritis. 

Dr.  Gary  Nelson  Dunlap,  Middlebrook,  Va.,  C.  P.  &  S.,  '93,  aged 
46,  died  at  his  home,  August  2, 

BOOK  REVIEWS 

Hospital  Laboratory   Methods.     By   Frank    A.    McJunkin,    A.M. 
M.D.,   Professor  of  Pathology,,   Marquette  University  School 
of   Medicine,    Milwaukee,    Wis.     Philadelphia:  P.    Blakiston's 
Son  and  Company.     Cloth,  $1.25  net.     1916. 
The  book  is  a  simplified  compendium  on  the  ordinary  methods 
employed  in  the  laboratory,  embracing  the  ordinary  test  used  in 
the  various  analyses  of  urine,  blood,  sputum,  gastric  juice,  feces, 
etc.     Except  in  the  routine  tests  it  is  a  useless  tax  of  the  memory 
to  carry  the  various  formulas  in  the  mind.     Therefore  when  an  out 
of  the  ordinary  test  is  to  be  made,  the  laboratory  man,  be  he  stu- 
dent, technician  or  clinician  must  resort  to  a  book  for  the  informa- 
tion desired.     For  such  purposes  McJunkin's  Laboratory  Methods 
will  be  found  brief,  to  the  point,  but  absolutely  reliable  and  depend- 
able.    It  gives  us  great  pleasure  to  recommend  it  to  those  of  our 
readers  who  are  contemplating  the  purchase  of  a  compact  work 
on  the  technic  of  the  laboratory. 

Manual  of  Normal  Histology.     By  Tilghman  B.  Marden,  A.B., 
M.D.,  Professor  of  Histology  and   Embryology  in  University 
of  Maryland  School  of  Medicine  and  College  of  Physicians 
and  Surgeons,  Baltimore,  Md.     Baltimore:  A  Hoen  and  Com- 
pany.    Cloth,  $3.25  net.     1916. 
A  teacher  of  physiology  can  not  assume  that  his  students  remem- 
ber the  details  of  the  normal  finer  architecture  of  the  organs,  when 
he  discom'ses  upon  the  regular  life  processes   these   very   organs 
are  called  on  normally  to  perform. 

Therefore  it  is  unavoidable  to  refresh  the  mind  of  the  student  on 
the  normal  histology  of  every  organ  before  its  function  is  lectured 
on.  This  is  exceedingly  important  with  the  freshman  class,  the 
students  of  which  are  in  ignorance  concerning  histology. 


64  BOOK   REVIEWS 

Hence  the  justification  of  the  phj^siologist  to  teach  histology, 
but  herein  hes  also  the  most  important  viewpoint  from  which  a 
physiologist  must  judge  a  work  on  histology.  This  personal  stand- 
point is  much  influenced  by  the  question,  How  much  are  the  under- 
standing and  comprehension  of  the  normal  processes  of  life  aided 
by  this  new  histolog}-? 

To  get  rid  of  the  severest  criticism  at  once  I  may  say  that  the 
author  has  neglected  this  great  assistance  he  could  have  given  to 
physiology  in  a  number  of  the  chapters. 

In  Chapter  IX,  The  Alimentary  Tract,  he  has  due  regard  for 
function,  but  in  Chapter  VI  on  the  Nerve  Tissue  I  fail  to  notice 
a  composite  picture  of  the  relative  grouping  of  the  various  neurones 
in  the  different  parts  of  the  gra}^  cortex.  The  single  illustration, 
figure  107,  on  page  159,  does  not  suflfice  for  this.  And  in  Chapter 
VII  on  the  Heart  and  Blood  Vessels  I  miss  the  description  of  the 
auricular-ventricular  muscle  bundle  of  His,  and  that  wonderful 
muscular  network  spread  over  the  inside  of  the  ventricles  and  known 
as  the  Purkinje  fibers  are  not  described  nor  referred  to. 

The  volume  itself  contains  200  pages  with  104  very  good  illus- 
trations and  a  well  itemized  index. 

Dr.  Harden  gives  evidence  of  being  a  master  of  technique.  The 
tinctorial  hardening  mounting  as  well  as  microtone  technique  are 
presented  in  a  manner  that  is  indicative  of  broad  experience.  In 
an  appendix  the  methods  of  fixation,  dehydration,  embedding,  cut- 
ting, staining  and  clarifj^ing  are  given  with  admirable  clearness  and 
precision.  The  beginner,  for  whom  this  work  is  intended,  will  soon 
be  able  to  understand  these  methods  from  the  exact  manner  in  which 
they  are  given. 

The  microphotographs  are  reproduced  with  care  and  a  satisfactory 
definition.  The  diagrammatic  illustrations  of  the  finer  architec- 
ture of  some  of  the  organs,  especially  of  the  liver  and  the  kidney, 
are  most  instructive  and  cannot  fail  to  facilitate  the  ready  compre- 
hension of  these  structures.  There  is  a  laudable  effort  to  make 
intelligible  the  meaning  of  different  words  by  explaining  their  deriva- 
tion which  in  didactic  practice  is  onl}^  too  frequently  neglected  by 
teachers,  for  the  derivation  of  the  name  of  a  cell  or  a  tissue  as  a 
rule  explains  its  function. 

The  text  is  clear,  and  there  is  a  studious  avoidance  of  long  and 
involved  sentences.  Altogether  the  work  bespeaks  of  many  years 
of  diligent  effort  to  create  a  real  and  helpful  guide  to  the  student 
of  histology. 


LOUIS  McLANE  TIFFANY 


BULLETIN 

OF  THE 

University  of  Maryland  School 
OF  Medicine 

AND 

College  of  Physicians  and 
Surgeons 

Successor  to  The  Hospital  Bulletin,  of  the  University  of  Maryland, 
Baltimore  Medical  College  News,  and  the  Journal  of  the  Alumni  Asso- 
ciation of  the  College  of  Physicians  and  Surgeons 

Vol.  I  NOVEMBER,    1916  No.  4 

LOUIS  McLANE  TIFFANY 
By  Ridgely  B.  Warfield,  M.D. 

In  the  death  of  Dr.  Tiffany  the  community  has  lost  a  citizen  of 
first  importance,  the  medical  profession  a  leader  in  American  surgery 
of  unusual  quality  and  prominence,  the  University  of  Maryland 
one  of  her  most  gifted  and  distinguished  teachers  and  sons,  and  his 
intimates  and  associates  a  friend  and  companion  of  delightful  per- 
sonality and  of  rare  characteristic  charm. 

To  the  student  body  and  many  of  the  younger  men  about  the 
University  Dr.  Tiffany  was  known  only  as  a  commanding  figure 
of  the  past  although  his  work  was  probably  recalled  in  every  day's 
teaching  within  her  walls.  To  those  men  who  have  been  privi- 
leged in  close  association  to  work  for  Dr.  Tiffany  and  with  him, 
his  immeasurable  influence  holds  today  little  diminished  in  the 
dozen  years  of  his  retirement. 

In  the  medical  department  of  the  University  throughout  the 
century  of  her  existence  among  those  in  her  service  and  in  control 
of  her  destiny  have  been  many  eminent  teachers.  Of  these  we  be- 
lieve there  have  been  none  more  noteworthy  or  of  greater  measure 
than  Dr.  Tiffany.  Naturally  strong  in  fitness,  physique  and  tem- 
perament, by  education,  cultivation  and  training,  he  brought  to 
his  work  an  admirable  equipment. 

65 


66  RANDOLPH   WINSLOW 

Probably  no  one  in  the  history  of  the  University  exercised  a 
wider  or  more  fruitful  influence  on  larger  bodies  of  men.  We  are 
reminded  how  potently  he  prevailed  through  his  busy  life;  of  the 
inevitable  thoroughness  of  his  work,  of  his  kindly  consideration 
for  the  sick,  the  individual  rich  or  poor  without  distinction,  of  his 
exceeding  gentleness,  of  his  facinating  way  with  children,  of  his 
compelling  authority,  of  his  strength  and  skill  and  splendid  judg- 
ment, and  of  the  illuminating  force  of  his  chnical  teaching. 

His  active  career  was  terminated  abruptly  by  ill  health  and  in 
the  years  that  followed,  when  not  disabled,  with  gun  and  rod  and 
other  diversion,  with  large  capacity  for  enjojmient  he  serenely 
filled  his  daj^s. 

He  died  suddenly  at  his  country  home  in  Virginia  where  at  the 
end  of  a  happy  beautiful  day  close  to  the  heart  of  nature  which 
he  loved  "God's  finger  touched  him,  and  he  slept." 

GUNSHOT  WOUNDS  OF  THE  INTESTINES^ 

By  Randolph  Winslow,  M.D.,  LL.D. 

Professor  of  Surgery 

I  am  fortunate  in  being  able  to  bring  before  you  today  two  cases 
of  gunshot  wounds  of  the  intestines  which  entered  the  hospital  within 
a  week  of  each  other  and  are  convalescing  satisfactorily.  One  case 
was  brought  in  at  night  and  was  operated  on  by  Dr.  C.  R.  Edwards. 

Case  1.  The  patient  is  a  healthy  negro  man,  20  years  of  age 
•  who  was  shot  in  the  back  on  the  left  side,  on  September  23,  1916 
at  8.30  p.m.,  with  a  38  calibre  pistol,  the  bullet  passing  forwards 
and  escaping  through  the  antero-lateral  abdominal  wall.  He  was 
brought  to  the  hospital  about  11.30  p.m.,  and  was  operated  on  within 
four  hours  of  the  time  of  receipt  of  injury.  Four  perforations  of 
the  small  intestine  were  found  and  sutured.  He  was  drained  both 
in  front  and  behind.  For  a  few  days  after  the  operation  his  tempera- 
ture and  pulse  were  considerably  increased  but  this  soon  subsided 
and  now  after  the  lapse  of  ten  days  he  is  practically  convalescent. 
The  man  was  operated  on  promptly  and  skillfully  by  Dr.  Edwards 
and  he  is  to  be  congratulated  on  the  successful  issue  of  the  case. 

Case  II.  A  colored  boj'-,  9  years  of  age,  was  shot  in  the  abdomen 
on  September  16,  1916  about  3  p.m.,  and  reached  hospital  abou1 

^  Clinical  lecture  delivered  at  the  University  Hospital  on  October  3,  1916. 


GUNSHOT   WOUNDS   OF   THE    INTESTINES  67 

three  hours  later.  The  weapon  was  a  22  cahbre  pistol  in  the  hands 
of  a  playmate  and  the  injury  was  accidental.  The  missile  entered 
the  abdomen  about  2  inches  to  the  right  of  the  umbilicus  and  on  the 
same  level  and  there  was  no  wound  of  exit.  The  abdomen  was 
opened  by  an  incision  through  the  right  rectus  muscle  and  some 
bloody  fluid  escaped  from  the  cavity.  The  intestines  were  consid- 
erably distended  with  what  appeared  to  be  undigested  apple  or 
other  fruit.  Two  perforations  were  found  on  the  convex  border  of 
two  loops  of  jejunum  several  inches  apart.  The  bullet  apparently 
grazed  the  overlying  coils  without  penetrating  the  cavity  of  the 
intestine,  as  there  was  no  wound  of  exit  in  the  intestine,  nor  could 
the  missile  be  found.  There  was  some  soiling  of  the  peritoneum 
but  no  large  escape  of  intestinal  contents.  Some  of  the  undigested 
intestinal  contents  were  expressed  through  the  holes  in  the  bowel. 
The  intestinal  openings  were  closed  with  two  or  three  rows  of  silk 
sutures,  the  area  of  injury  cleansed  and  drainage  tubes  and  cigar- 
ette drains  were  placed  in  the  pelvis  and  at  the  site  of  injury.  The 
abdominal  incision  was  closed  up  to  the  drains.  The  patient  was 
placed  in  the  Fowler  position  and  proctoclysis  instituted.  Nothing 
was  allowed  by  mouth  for  forty-eight  hours  when  small  quantities 
of  fluids  were  given.  Soon,  however,  vomiting  occurred  and  noth- 
ing passed  through  his  bowels  and  later  cutting  pains  were  experi- 
enced with  some  distension  of  the  abdomen.  This  continued,  the 
leucocyte  count  increased  and  it  became  evident  that  an  intestinal 
obstruction  was  present.  Six  days  after  he  was  shot  it  became 
necessary  to  re-open  his  abdomen  under  ether  anesthesia.  The 
upper  part  of  the  small  intestine  was  distended,  the  lower  portion 
collapsed.  The  intestine  was  punctured  in  two  places  to  allow  the 
feces  and  flatus  to  escape.  There  seemed  to  have  been  a  volvulus 
of  the  small  intestine  which  was  relieved.  The  bullet  holes  in  the 
intestines  were  found  to  be  securely  closed  and  the  holes  made  by 
the  trochar  were  also  sutured.  The  intestines  were  washed  off 
and  a  single  small  drainage  tube  was  inserted  into  the  pelvis.  The 
boy  was  returned  to  bed  and  placed  in  the  Fowler  position  and  proc- 
toclysis by  the  Murphj^  method  was  instituted.  From  this  time  he 
did  well,  pam  and  vomiting  ceased  and  flatus  and  feces  passed  in  a 
natural  manner  and  he  is  now  convalescent  except  for  a  granulat- 
ing wound  which  became  infected  during  the  last  operation. 

Gun  shot  wounds  of  the  abdomen  are  very  serious  injuries  and 
their  gravity  depends  to  a  large  extent  upon  whether  the  solid  or 


68  RANDOLPH   WINSLOW 

hollow  organs  are  injured.     During  the  late  American  Civil  War 

gunshot  wounds  of  both  large  and  small  intestines  were  followed  by  a 
mortality  of  80  per  cent,  while  Otis  (who  compiled  the  surgical  statis- 
tics of  the  war)  says  that  not  a  single  authentic  case  of  recovery  from 
a  penetrating  wound  of  the  small  intestine  was  recorded.  We 
know  that  in  civil  life  gunshots  of  the  small  intestines  are  practi- 
cally always  fatal  unless  prompt  operation  is  done  and  the  perfora- 
tions sutured.  When  this  is  done  promptly  within  a  few  hours  of 
the  receipt  of  the  injury  from  50  to  60  per  cent  of  the  cases  will 
recover. 

The  first  thing  I  wish  to  impress  on  you  is  that  it  is  not  only 
unnecessary  but  injurious  to  probe  the  wound,  either  with  a  probe 
or  with  your  finger,  in  order  to  determine  if  the  gunshot  has  pene- 
trated the  peritoneal  cavity.  When  you  are  called  to  a  case  of 
gunshot  or  stab  wound  of  the  abdomen,  do  not  probe  it  but  place  a 
sterile  dressing  on  the  wound,  or  a  clean  piece  of  cloth,  or  leave  it 
alone  entirely.  Have  the  patient  conveyed  at  once  to  a  hospital, 
if  possible,  or  to  the  place  at  which  he  will  remain  and  place  him 
in  the  hands  of  the  best  surgeon  you  can  secure.  Do  not  delay  in 
order  to  see  if  serious  symptoms  will  result  but  do  so  at  once.  If 
the  patient  is  operated  on  within  a  few  hours  his  prospects  of  re- 
covery will  be  greatly  enhanced;  if  the  operation  is  not  done  within 
twenty-four  hours  he  will  probably  die.  When  the  patient  is  taken 
to  the  place  at  which  he  is  to  remain,  his  abdomen  should  be  cleansed 
by  scrubbing  with  soap  and  water  or  by  painting  with  tincture  of 
iodine  and  then  the  wound  may  be  explored  by  an  incision  through 
it,  or  by  an  incision  at  a  more  convenient  place.  If  it  is  evident 
that  no  penetration  of  the  cavity  has  occurred,  the  incision  is  closed 
and  but  little  delay  in  recovery  ought  to  result.  If  on  the  con- 
trary penetration  has  occurred  then  a  careful  search  for  visceral 
injuries  should  follow.  The  symptoms  of  an  intra-abdominal  lesion 
may  at  first  be  entirely  absent  and  we  are  not  justified  in  waiting 
for  them  to  develop  before  undertaking  an  operation.  The  most 
evident  symptom  is  the  location  of  the  wound.  If  a  gunshot  wound 
has  been  received  on  the  front  or  side  of  the  abdomen  it  is  probable 
that  penetration  has  occurred  and  the  abdomen  should  be  opened; 
but  the  wound  may  be  in  the  back,  as  in  the  case  operated  on  by 
Dr.  Edwards,  and  unless  there  are  definite  indications  that  the  bul- 
let did  not  enter  the  peritoneal  cavity  laparotomj^  should  be  per- 
formed.    At  times  the  external  wound  may  be  in  the  thorax  and 


GUNSHOT   WOUNDS    OF   THE    INTESTINES  69 

the  missile  passing  downwards  may  cause  serious  and  even  fatal 
intra-peritoneal  traumatisms.  Whenever  a  gunshot  wound  is  so 
placed  that  it  seems  probable  that  it  may  have  entered  the  abdomi- 
nal cavity  it  will  be  safer  to  explore  the  abdomen  than  to  leave  the 
case  in  uncertainty.  When  the  abdomen  is  explored  what  do  we 
look  for?  First,  for  hemorrhage.  As  a  rule  there  is  not  much 
bleeding  from  a  gunshot  wound,  while  the  reverse  is  true  in  the 
case  of  stab  wounds.  In  either  case  if  active  bleeding  is  going  on 
it  must  be  controlled  with  clamp  or  ligature.  Second,  for  visceral 
lesions.  The  hollow  organs  are  much  more  likely  to  be  injured  than 
the  solid  ones  and  their  lesions  are  much  more  fatal.  A  bullet  tra- 
versing the  abdomen  from  before  backwards  below  the  umbilicus 
can  scarcely  fail  to  produce  several  perforations  of  the  small  intes- 
tines, while  one  passmg  transversely  or  obhquely  across  the  cavity 
is  almost  certain  to  cause  many  lesions,  often  widely  separated  from 
each  other  and  involving  many  structures.  Notwithstanding  the 
visceral  lesions  there  is  usually  not  much  escape  of  intestmal  con- 
tents for  several  hours,  as  the  bowel  is  paralyzed  for  a  while;  later 
when  peristalsis  becomes  reestablished  there  wil]  be  extensive  extrav- 
asation of  feces  into  peritoneal  cavity;  hence  the  importance  of 
early  operation  before  extravasation  and  peritonitis  has  occurred. 
When  intestinal  perforations  are  found  they  should  be  closed  with 
two  rows  of  silk  sutures.  If  the  bowel  is  extensively  torn  or  if  two 
or  more  openings  are  in  close  proximity  it  may  be  necessary  to  re- 
sect the  bowel  and  do  a  lateral  anastomosis.  If  the  small  intestine 
is  penetrated  on  its  mesenteric  border  it  will  usually  be  safer  to 
resect  the  bowel  at  that  point.  In  most  cases  it  is  best  to  make  the 
abdominal  incision  in  or  near  the  mid  line  as  it  offers  better  facili- 
ties for  a  thorough  exploration  of  Lhe  intestinal  tract,  which  is 
usually  necessary.  I  have  been  speaking  of  gunshot  wounds  of  the 
intestines  and  especially  of  the  small  intestines,  but  the  same  prin- 
ciples advocated  apply  to  stab  wounds  of  the  viscera  equally  as  well, 
and  also  to  similar  injuries  of  the  other  hollow  and  solid  organs. 
Such  organs  as  the  liver,  spleen  and  kidneys  are  frequently  mjured 
and  usually  bleed  freely.  Sometimes  the  lacerations  may  be  sutured 
or  packed  with  gauze,  or  in  the  case  of  the  spleen  or  kidney  removal 
of  these  organs  may  be  demanded. 

In  conclusions  let  me  impress  these  facts  on  you: 
First.     Do  not  probe  the  wound;  let  the  wound  alone. 
Second.     Get  the  patient  to  a  hospital  as  soon  as  possible,  or  to 
his  home  or  abode. 


70  RANDOLPH   WINSLOW 

Third.  Do  not  delay  operation;  these  injuries  are  mortal  if 
untreated  and  the  sooner  operation  is  done  the  greater  the  chance 
of  recovery. 

Fourth.  This  is  emergency  surgery  and  if  no  surgeon  is  available 
it  is  the  duty  of  the  physician  who  sees  the  case  to  open  the  abdo- 
men and  repair  the  lesions  the  best  he  can. 

ADDENDUM 

On  October  13,  1916,  the  following  case  was  admitted  to  the 
University  Hospital  and  was  operated  on  by  Prof.  R.  Winslow. 

G.  B.,  negro,  26  years  of  age  was  shot  in  the  abdomen  about  12 
o'clock  noon  and  was  brought  to  the  hospital  about  two  hours  after 
the  injury.  The  No.  38  bullet  entered  the  left  side  of  the  abdomen 
about  2^  inches  from  the  middle  line  and  a  little  below  the  level  of 
the  umbilicus  and  ranging  to  the  right  can  be  felt  under  the  skin  of 
the  right  buttock.  There  was  some  bleeding  from  the  wound, 
but  not  much  pain  was  felt  and  no  vomiting  was  present.  Pulse 
70,  temperature  95,  respiration  16  on  admission. 

Operation  about  three  and  a  half  hours  after  injury.  Incision 
near  the  mid  line.  There  was  considerable  liquid  and  clotted  blood 
in  the  peritoneal  cavity  and  some  bleeding  from  injured  mesenteric 
vessels.  These  were  clamped  and  tied  and  the  clots  removed  by 
spongmg.  A  search  for  lesions  revealed  eight  bullet  holes  in  the 
small  intestine  and  several  perforations  of  the  mesentery.  These 
openings  were  closed  by  sutures  except  two  which  were  directly 
opposite  each  other,  one  on  the  free  surface  of  the  intestine  and  one 
between  the  layers  of  the  mesentery  on  the  mesenteric  border. 
Owing  to  the  possibly?-  injury  to  the  vascular  supply  it  was  thought 
best  to  resect  the  intestine  at  this  point  and  do  a  lateral  anastomosis. 
The  bullet  passed  under  the  large  intestine  without  injuring  it.  The 
abdomen  was  flushed  with  hot  salt  solution  and  drains  placed  in  the 
pelvis  and  at  the  site  of  the  anastomosis.  Notwithstanding  the 
extensive  injuries  there  was  very  little  escape  of  intestinal  contents 
into  the  peritoneal  cavity.  Proctoclysis  was  instituted,  the  patient 
propped  up  and  nothing  by  mouth  allowed  for  forty-eight  hours, 
afterwards  liquids  were  given  and  in  a  few  days  soft  diet.  He  did 
well,  had  but  little  elevation  of  temperature  and  is  now  convalescent. 


LETTERS    OF   APPRECIATION  71 

LETTERS  OF  APPRECIATION 

The  following  letters  of  appreciation  may  be  of  interest  to  our 
readers. 

Alliance,  Ohio, 
October  18,  1916. 
My  dear  Dr.  Rowland. 

Today  I  received  the  Bulletin  of  the  combined  schools.  I  was  sorry  to 
learn  that  Doctors  Ashby  and  Simon  had  passed  away,  and  I  also  noticed 
that  Dr.  David  Streett  was  no  more. 

This  Bulletin  has  done  me  a  great  deal  of  good,  as  I  have  almost  become 
a  back  number.  All  I  do  is  work.  I  do  not  have  time  even  to  read  or  go 
away  from  home,  or,  at  least,  I  do  not  take  the  time.  I  am  glad  to  see  your 
appointment  to  the  Dean's -chair.  Please  mail  to  me  your  1916  announce- 
ment as  I  believe  I  shall  make  the  attempt  this  year  to  come  to  Baltimore  and 
take  a  course  in  the  consolidated  school;  that  is,  if  I  am  eligible  to  enter. 
As  ever,  I  remain. 

Yours  sincerely, 

L.  A.  Crawford,  B.M.C.  '92. 

Washington,  D.  C, 
October  21,  1916. 
My  dear  Dr.  Rowland. 

Seated  by  my  desk,  I  have  just  finished  reading  completely  your  Bulle- 
tin; for  which  I  thanl^^  you.  But  I  do  not  thank  you  for  the  information 
which  it  contained — the  announcement  of  the  death  of  Professor  Ashby. 

Little  does  the  average  student  appreciate  the  untiring  kindness  and  in- 
terest a  teacher  has  for  his  pupil.  In  this  connection,  I  wish  to  state  that 
Professor  David  Streett  and  Professor  Ashby  stand  out  in  my  memory  in  a 
manner  never  to  be  forgotten  for  their  kindness  to  me  while  a  student  under 
their  guidance.  Well  do  I  remember  the  day  when  I  applied  to  Professor 
Ashby  for  my  final  examination.  I  had  asked  him  several  times  when  it 
would  occur,  and  he  had  put  me  off  from  time  to  time,  which  made  me  more 
nervous.  On  this  occasion  he  said  in  his  big  voice,  "Son,  your  time  will 
come  soon  enough,  and,  as  I  have  been  watching  you,  I  do  not  think  you 
will  have  any  trouble."     Whew!  did  not  my  chest  puff  up  at  these  words. 

Enough  of  reminiscences.  I  wish  I  were  not  so  lax  in  the  duty  I  owe  my 
Alma  Mater.  Right  here  I  am  going  to  turn  over  a  new  leaf;  but  a  busy  man 
who  has  eighteen  years  of  practice  behind  him  sometimes  wishes  he  could  start 
all  over  again — at  least,  I  do. 

This  letter  is  full  of  nothing.  It  is  just  a  word  to  say  that  you  and  my 
other  teachers  often  spend  pleasant  fleeting  visits  with  me  when  they  pass  in 
memory  of  days  gone  by.  Congratulations  on  the  consolidation  of  the  Bal- 
timore Medical  College,  the  College  of  Physicians  and  Surgeons,  and  the 
University  of  Maryland.  My  deepest  wish  is  that  the  new  school  shall  be  the 
greatest  in  America. 

Yours  sincerely, 

A.  H.  Staples,  B.M.C,  1896. 


72         ERWIN  E.  MAYE9  AND  ARTHUR  F.  PETERSON 

New  Canaan,  Conn., 

October  19,  1916. 
My  dear  Rowland. 

My  mail  this  a.m.  included  the  October  issue  of  the  Bulletin.  I  feel  the 
loss  of  Professor  Ashby  very  much,  as  he  together  with  Professors  Streett  and 
Rheuling  was  to  me  more  dear  than  any  others  with  whom  I  came  into  con- 
tact, not  that  I  thought  any  less  of  any  member  of  the  Faculty. 

So  you  are  now  Dean,  while  I  am  still  plodding  along  as  usual,  and  still 
have  the  original  chemistry  outfit,  of  which  you,  no  doubt,  have  no  recol- 
lections. I  also  have  a  nice  home  in  Florida  with  a  large  citrus  grove,  where 
I  spend  from  four  to  six  months  every  winter. 

Give  my  regards  to  every  one  connected  with  the  old  Baltimore  Medical 
College. 

Yours  sincerely, 

C.  N.  Scoville,  M.D.,  B.M.C.,  1892. 

The  Samaritan  Hospital, 
Detroit,  Mich., 
October  23,  1916. 
Dear  Mr.  Winslow, 

I  am  taking  the  opportunity  to  inform  you  that  I  am  the  senior  interne 
of  this  50  bed  hospital,  and  I  have  to  be  the  first  assistant  at  all  operations, 
of  which  there  are  at  least  three  or  four  going  on  daily.  Thus  I  am  getting 
a  good  experience  in  surgery  in  which  I  am  so  much  interested,  and  for  the 
course  in  which  I  cannot  find  words  to  express  my  thanks  to  Professor  Wins- 
low.  I  have  his  picture  above  my  desk  and  when  I  look  at  it  I  am  reminded 
of  his  saying  "Gatsopoloulos  how  are  Venizelos  and  Constantinos  today?" 
Greece  as  you  know  is  in  a  labarynthian  state  now  and  it  is  too  bad  that  the 
two  men  of  the  hour,  Venizelos  and  the  King,  have  not  come  to  an  agree- 
ment.    Let  us  hope  this  terrible  war  will  soon  be  over. 

Respectfully  yours, 

P.  N.  Gatsopoulos,  M.D. 

(Extract  from  a  letter  to  Mr.  Caleb  Winslow,  Registrar.) 
[Dr.  Gatsopoulos  was  at  one  time  Mayor  of  his  native  town  in  Epirus, 
Greece,  at  that  time  under  Turkish  rule,  and  was  imprisoned  on  account  of 
his  protest  against  unjust  and  unlawful  collection  of  taxes  by  the  Ottoman 
oflBcials.] 

STRONGYLOIDES  INTESTINALIS 

By  Erwin  E.  Mayer,  M.D.  and  Arthur  F.  Peterson,  M.D. 
Mercy  Hospital  Resident  Staff,  Baltimore,  Maryland 

The  case  presented  here  is  one  which  occurred  in  the  medical 
service  of  Mercy  Hospital  and  is  reported  through  the  courtesy  of 
the  visiting  staff. 

The  chief  interest  of  this  case  lies  in  the  fact  that  the  patient  had 
been  a  resident  of  Maryland  (Rock  Hall)  for  the  past  eighteen  years 


STRONGYLOIDES   INTESTINALIS  73 

and  has  never  been  in  a  tropical  climate.  For  the  past  eight  months 
he  has  been  treated  for  chronic  rheumatism,  his  symptoms  being 
such  as  to  make  one  suspect  the  presence  of  either  joint  or  muscular 
infection. 

In  scanning  the  literature  for  previous  case  reports  of  strongy- 
loides,  those  occurring  in  this  country  have  practically  all  had  the 
characteristic  symptoms  of  diarrhea  and  digestive  disturbances, 
which  this  patient  has  hardly  complained  of  at  all.  His  symptoms 
have  been  rather  atypical  and  contradictory  and  the  presence  of 
the  strongyloides  was  discovered  during  a  routine  examination  of 
the  man's  secretions  and  excretions,  the  blood  examination  being  the 
first  sign  of  importance  to  make  us  suspect  intestinal  parasites. 

Following  is  the  history  and  report  of  the  various  examinations 
made. 

B.  McC,  age  74;  occupation,  farmer;  admitted  to  hospital  Au- 
gust 10,  1916. 

Complaint,  severe  pains  in  the  arms,  joints  and  muscles;  also 
pains  in  the  legs,  from  knees  down.  Weakness  in  arms  and  legs. 
Tenesmus  and  marked  constipation.     Stiffness  of  neck. 

Family  History.     Father  died  of  yellow  fever;  otherwise  negative. 

Personal  History.  Had  measles  as  a  child.  During  adolescence 
had  malaria  and  pneumonia,  otherwise  negative. 

Head.     Negative  as  to  past  history, 

Cardio-respiratory.     Negative  as  to  past  history. 

Gastro-intestinal.  Has  always  suffered  with  constipation.  Appe- 
tite has  been  good,  but  digestion  poor.  No  diarrhea.  Has  had  no 
vomiting  or  nausea  at  any  time.  No  pain  in  abdomen,  some 
tenesmus. 

Genito-urinary .  Urinates  two  or  three  times  each  night,  usual 
frequency  during  day.  Drinks  little  water.  Has  slight  inconti- 
nence.    History  of  lues  and  gonorrhoea  negative. 

Habits.  Drinks  beer  and  whiskey  moderately.  Has  been  work- 
ing each  day.     Not  addicted  to  drugs. 

Present  Illness.  In  December,  1915,  patient  began  to  be  troubled 
with  severe  cramps  in  legs.  This  spell  of  illness  laid  him  up  for  a 
few  days  and  then  he  resumed  his  work.  On  the  1st  of  February 
he  had  an  attack  of  what  he  called  ''grippe" — general  aching  all 
over  body  and  stiffness  of  neck.  At  this  time  also,  he  had  some 
swelling  of  his  legs  and  hands.  This  incapacitated  hmi  for  a  few 
days  when  he  again  engaged  in  his  work.     From  this  time  on  he 


74  ERWIN   E.    MAYER   AND    ARTHUR   F.    PETERSON 

worked  steadily  until  he  came  to  the  hospital,  but  still  continued 
to  have  pains  in  his  arms  and  legs.  He  also  complained  severely 
of  constipation.  He  was  sent  to  the  hospital  on  account  of  the 
pains  in  his  muscles  and  joints  and  general  weakness. 

Physical  Examination.  Old  man;  very  weak;  hardly  able  to  sit 
up;  apparently  suffering  no  acute  pain;  answers  questions  readily; 
mentality  good;  cheerful  and  optimistic. 

Head.     Negative  findings.     Teeth  fair  but  no  pyorrhea  or  cavities. 

Neck.     Posterior  glands  of  neck  enlarged. 

Chest.     No  positive  findings  except  slight  emphysema. 

Heart.     Slight  myocarditis. 

Pulse.     Evidence  of  arterio-sclerosis. 

Abdomen.  Some  distended  veins  present,  right  mguinal  hernia. 
Liver  and  spleen  not  enlarged.     No  masses  or  abnormalities. 

Extremities.  Clubbing  of  fingers,  which  are  rather  short  and 
pointed.  Grip  weak.  Some  emaciation  of  arms  and  legs  and 
weakness  present  to  a  marked  degree. 

Glands.     Cervical,  inguinal  and  epitrochlear  enlarged. 

Laboratory  findings. 

Urine  Blood 

Color,  amber  Hemoglobin,  60  per  cent 

Reaction,  acid  .  Red  count,  3,480,000 

Sp.  gr.,  1018  White  count,  10,500 

Ppt.,  flocculent  Differential 

Albimaen,  trace  Small  mono's,  15  per  cent 

Sugar,  none  Large  mono's,  6  per  cent 

Bile,  none  Poly's,  52  per  cent 

Acetone,  none  Eosinophiles,  26  per  cent 

Diacetic,  none  Basophiles,  1  per  cent 

Indican,  none  Myelocytes,  0  per  cent 
Microscopical : 

Triple  phosphate  crystals 

Few  granular  casts 

Stool  examination.  Shows  presence  of  a  large  number  of  strongy- 
loides  intestinalis.  Sometimes  as  high  as  ten  or  twenty  small, 
wriggling  worms  in  the  field  under  low  power  of  microscope.  The 
parasites  are  very  active  quickl}^  disappearing  from  the  field,  while 
.  others  shoot  past  the  eye  from  other  parts  of  the  slide.  The  worms 
have  the  characteristic  appearance  which  have  been  described  in 
the  books  on  clinical  diagnosis.  The  specimen  was  examined  and 
the  diagnosis  verified  by  Drs.  Charles  E.  Simon  and  C.  C.  W.  Judd. 


STRONGYLOIDES   INTESTINALIS  75 

Examination  of  muscle  section.  As  trichinosis  was  at  first  sus- 
pected by  the  symptoms  of  pain  in  the  muscles  and  the  pronounced 
eosinophiha,  a  section  of  muscle  from  the  gastrocnemius  was  dis-» 
sected  out  under  local  anaesthesia  and  examined  for  the  presence 
of  trichina  by  Dr.  Standish  McCleary,  but  diagnosed  as  negative. 

Proctoscopic  examination.  This  examination  was  made-  in  an 
endeavor  to  see  if  any  possible  changes  were  present  in  the  mucous 
membrane.  This  latter  was  found  to  be  swollen,  oedematous,  red 
and  showed  signs  of  inflammatory  process.  No  ulcerations  were 
found. 

REMARKS 

The  presence  of  a  very  high  eosinophiha,  which  was  found  during 
a  routine  blood  examination  first  drew  our  attention  to  the  prob- 
able presence  of  an  intestinal  parasite  or  a  trichina  infection.  Until 
this  examination  was  made  we  had  no  suspicion  of  such  a  disease 
being  present  on  account  of  the  patient's  history  and  his  length  of 
residence  in  Maryland. 

The  importance  of  routine  examination  of  the  urine,  blood  and 
stool  of  each  patient  who  presents  himself  on  account  of  illness 
is  demonstrated  in  this  particular  case.  This  is  again  an  in- 
stance of  several  rather  important  diagnoses  which  have  been  made 
during  a  thorough  examination.  In  many  instances  the  excretions 
and  secretions  of  the  patient  are  found  to  be  perfectly  normal  and 
it  is  only  in  unusual  cases  as  this  that  we  find  our  diagnosis  to  be 
often  entirely  dependent  on  the  results  of  a  careful  history  and 
examination. 

Since  the  patient  has  been  admitted  to  the  hospital  we  have  found 
the  parasites  to  be  present  in  his  stools  almost  daily,  the  number 
varying  from  day  to  day.  Recently  the  parasites  seem  to  be  getting 
less.  The  percentage  of  eosinophiles  has  also  decreased,  the  last 
estimation  showing  19  per  cent. 

We  have  tried  to  treat  this  patient  according  to  the  Porto  Rican 
method  of  dealing  with  uncinaria,  as  the  recent  literature  does  not 
recommend  any  drug  as  specific.  The  various  vermifuges  do  not 
seem  to  have  any  effect  on  this  variety  of  parasite.  Thymol  in 
large  doses  has  given  us  the  best  results  so  far  but  has  not  helped 
the  patient  to  entirely  free  himself  of  the  strongyloides. 


76  R.    W.    LOCHER 

EXPERIMENTAL  STUDY  OF  McDONALD'S   SOLUTION 

AS   AN  ANTISEPTIC   IN   SURGICAL  TECHNIQUE 

AND  ETHER  ANESTHESIA  PER  RECTUM 

By  R.  W.  Locher,  M.D. 

Associate  Professor  of  Operative  and  Clinical  Surgery 
University  of  Maryland  School  of  Medicine  and  College  of  Physicians  and 

Surgeons 

In  presenting  a  summary  of  a  course  of  experiments  on  the  use  of 
McDonald's  solution  as  an  antiseptic  in  surgical  technique  and  of 
ether  anaesthesia  per  rectum,  I  am  fully  cognizant  of  the  fact  that 
perhaps  these  subjects,  to  some  of  you,  are  not  new,  yet  they  are 
sufficiently  new  to  the  general  profession  that  a  resume  of  the  gen- 
eral plan  followed  in  my  experiments  may  not  be  without  interest. 
The  considerable  variation  of  the  technique  used  in  various  insti- 
tutions proves  that  the  profession  is  not  of  one  mind  as  to  what  is 
best;  also,  that  none  of  the  usual  methods  have  proven  entirely 
satisfactory. 

The  object  of  these  experiments  was  not  for  the  purpose  of  original 
research,  but  to  prove  to  my  own  satisfaction,  whether  or  not,  the 
use  of  McDonald's  solution  fulfilled,  in  actual  practice,  the  claims 
made  by  its  advocates;  though  apparently,  this  work  has  been 
very  carefully  done,  in  many  instances,  we  all  know  how  prone  the 
enthusiast  is  to  exaggerate  the  value  of  anything  new  that  he  may 
be  fathering. 

All  of  the  experiments  were  conducted  on  animals,  so  I  have  drawn 
no  conclusions  of  results  obtained,  in  so  far  as  their  application 
to  the  human  subject  is  concerned. 

The  work  throughout  was  conducted  on  a  practical  basis,  with 
the  one  idea  in  mind  that  it  is  the  final  result  which  counts  and  on 
which  success  or  failure  depends.  In  view  of  this  fact,  the  bacterio- 
logical side  of  our  work  is  conspicuously  absent,  this  phase  of  the 
subject  having  been  thoroughly  investigated  bj^  those  who  originally 
introduced  these  subjects  to  the  profession  and  others. 

Without  exception,  the  actual  experiments  were  conducted  by 
students,  under  my  supervision  and  direction,  in  conjunction  with 
the  regular  work  done  by  my  class  in  operative  surgery  on  animals 
at  the  College  of  Physicians  and  Surgeons,  during  the  past  year. 

The  advantage  of  McDonald's  solution  over  all  other  known  an- 
tiseptics, as  claimed  by  its  originator,  are  numerous,  chief  of  which 


STUDY  OF  MCDONALD  S  SOLUTION  AND   ETHER  ANESTHESIA         77 

are:  Its  superior  antiseptic  qualitj'^;  its  non-irritating  quality  when 
applied  to  the  unbroken  skin;  its  power  of  penetrating  to  the  lower- 
most layers  of  the  skin;  the  rapidity  of  its  action;  its  relative  cheap- 
ness, and  the  fact  that  it  can  be  used  repeatedly  without  deterioration. 
The  solution  is  made  of  the  following: 

Denatured  alcohol 60  parts 

Commercial  acetone 40  parts 

Pyxol 2  parts 

The  alcohol  is  used  chiefly  as  a  vehicle  although  it  possesses 
certain  dissolving  qualities.  The  denatured  variety  is  used  be- 
cause of  its  lessened  cost  over  pure  ethyl  alcohol.  Acetone  is  added 
because  of  its  power  of  penetration  and  of  dissolving  certain  fats 
and  oils  found  on  the  skin  which  resists  ordinary  solvents  and  which 
harbor  microorganisms.  The  commercial  acetone  is  just  as  effica- 
cious as  the  refined  and  is  much  less  expensive. 

Pyxol  is  the  antiseptic  and  in  addition  to  its  rapidity  of  action, 
is  capable  of  exerting  its  antiseptic  properties  in  the  presence  of 
albuminous  material. 

As  the  claims  of  the  virtues  of  this  solution  are  radical  and  far 
beyond  those  possessed  by  any  other  solution  now  in  use,  it  was 
determined  to  put  it  to  most  rigid  tests.  For  this  purpose,  it  was 
studied  from  the  following  standpoints: 

(1)  Its  usefulness  as  an  antiseptic  for  hand  sterilization  previous 
to  operations. 

(2)  Its  usefulness  for  resterilization  of  the  hands  during  opera- 
tions, after  contamination,  from  the  standpoint  of  rapidity  of  action. 

(3)  Its  usefulness  as  an  antiseptic  in  the  preparation  of  the  opera- 
tive field. 

(4)  Its  effect  on  the  skin  of  the  operator's  hands. 

(5)  Its  effect  on  the  patient's  skin  as  revealed  subsequent  to 
operation. 

In  order  to  test  its  efficiency  as  an  antiseptic  for  hand  steriliza- 
tion the  following  plan  was  instituted: 

As  the  presence  of  water  on  the  skin  is  unnecessary,  but  rather 
undesirable,  no  student  was  permitted  to  wash  his  hands  previous 
to  the  use  of  the  pyxol  solution,  even  though  perceptible  dirt  was 
present,  nor  was  he  permitted  to  manicure  his. nails  after  entering 
the  operating  room.  For  the  first  series  of  cases,  as  soon  as  the 
student  entered  the  operating  room,  he  prepared  his  hands  by  vigor- 


78  R.    W.    LOCHER 

ously  scrubbing,  in  pyxol  solution,  with  an  ordinary  hand  brush, 
for  a  period  of  one  minute  for  each  hand,  pajdng  particular  atten- 
tion to  his  nails,  then  with  a  piece  of  gauze  saturated  with  the  solu- 
tion, each  forearm  was  rubbed  for  a  period  of  one  ixdnute.  This 
completed  the  preparation,  save  the  application  of  rubber  gloves, 
which  gloves  were  sterilized  in  the  ordinary  manner  by  boiling  and 
then  immersed  in  a  1-20,000  bichloride  solution.  The  total  time 
occupied  in  preparing  the  hands  outside  of  putting  on  the  gloves 
was  four  minutes,  or  two  minutes  to  each  hand  and  forearm.  It 
might  be  of  interest,  in  passing,  to  state  that  the  hand  brush  and 
gauze  used  in  preparing  the  hands  were  not  sterilized  before  use 
but  were  dropped  into  the  pan  of  solution  unsterilized  at  the  time 
the  hand  preparation  began. 

In  the  next  series  of  cases,  the  hands  were  prepared  in  the  same 
manner  as  in  the  previous  series  but  the  use  of  rubber  gloves  was 
abandoned.  Subsequently,  the  time  of  preparation  of  each  hand 
was  diminished  from  two  minutes  to  one  minute  and  then  to  one- 
half  minute.  We  have  not  attempted  a  shorter  period  of  prepara- 
tion than  one-half  minute  for  each  hand,  as  no  claim  is  made  as 
to  the  efficiency  of  the  solution  under  30  seconds. 

At  the  point  of  our  experiments  when  we  were  occupying  but  one 
minute  of  time  for  the  preparation  of  each  hand,  it  was  discovered 
that  in  the  solution  we  had  been  using,  but  one-tenth  of  the  required 
strength  of  pyxol  had  been  used.  From  that  time  on,  the  proper 
strength  solution  was  used. 

To  prove  the  usefulness  of  the  solution  as  an  antiseptic  in  re- 
sterilization  of  hands  contaminated  during  operation,  the  various 
ones  engaged  in  the  operations,  were  required,  from  time  to  time, 
to  contaminate  their  hands  in  various  manners,  and  then  re-sterilize 
them  in  pyxol  solution  for  a  period  of  from  30  to  60  seconds. 

The  antiseptic  property  of  the  solution  used  in  preparing  the 
patient's  field  of  operation  was  tested  in  the  following  manner. 
The  evening  before  or  early  in  the  morning  of  the  day  of  operation, 
the  dog  was  given  a  bath  and  the  field  of  operation  shaved.  No 
other  preparation  was  attempted  until  the  dog  was  asleep  and  all 
was  ready  for  the  operation;  then  the  field  of  operation  was  rubbed 
moderately  for  from  30  to  60  seconds  with  a  gauze  sponge  saturated 
with  pyxol  solution.  As  soon  as  sterile  sheets  could  be  placed  in 
position,  we  proceeded  with  the  operation.  During  the  operation, 
quite  an  area  of  skin  around  the  incision  was  permitted  to  remain 


STUDY  OF  MCDONALD  S  SOLUTION  AND  ETHER  ANESTHESIA        79 

uncovered  and  the  skin  was  touched  by  the  hands  without  reserva- 
tion; furthermore  the  various  abdominal  viscera  were  permitted 
to  come  in  contact  with  the  sldn  as  frequently  as  possible. 

The  operations  done  during  the  course  of  our  experiments  con- 
sisted of  all  varieties  of  abdominal  operations.  Frequently  we 
operated  on  a  dog  as  soon  as  three  weeks  after  a  previous  operation 
was  performed.  In  two  cases,  the  second  operation  was  performed 
just  two  weeks  after  the  first.  Strange  as  it  may  seem,  of  the  three 
deaths  as  the  result  of  our  experiments,  two  of  them  were  the  two 
dogs  operated  on  the  second  time  at  the  end  of  two  weeks. 

In  sterihzing  the  hands,  if  the  skin  is  unbroken,  there  is  a  sen- 
sation of  penetration,  yet  no  evidence  of  irritation  is  noted  nor  was 
any  post  operative  irritation  ever  noted.  Just  what  effect  repeated 
and  frequent  sterilization  of  the  hands  day  after  day  would  have 
on  the  skin  we  have  not  been  able  to  demonstrate  although  the  origi- 
nator of  this  solution  admits  that  prolonged  use  of  same  is  apt  to 
cause  a  slight  irritation  of  the  skin.  After  thorough  scrubbing  of 
the  hands  with  soap  and  water  after  operation,  the  odor  of  the 
pyxol  still  persists  to  a  greater  or  less  degree.  The  odor  is  not  un- 
pleasant but  resembles,  to  a  certain  extent,  some  of  the  phenol 
derivatives. 

In  none  of  the  cases  where  the  operative  field  was  prepared  with 
pyxol  solution  was  there  ever  any  evidence  of  the  slightest  irrita- 
tion of  the  skin,  such  as  one  occasionally  sees  following  the  Iodine 
technique. 

The  solution  we  prepared  was  used  over  and  over  again.  After 
the  solution  had  been  used,  there  would  collect  at  the  bottom  of 
the  basin  quite  a  quantity  of  detritus  which  evidently  had  no  delete- 
rious effect  upon  the  efficaciousness  of  the  solution.  Before  return- 
ing the  used  solution  to  the  stock  container,  it  was  filtered  through 
ordinary  absorbent  cotton. 

Of  our  entire  series  of  cases  used  experimentally,  we  had  but 
three  deaths,  two  of  which  I  have  already  referred  to.  The  first 
case  was  that  of  a  medium  sized  rat  terrier  dog  on  whom  a  lateral 
anastomosis  was  done.  He  recovered  from  this  operation  in  ex- 
cellent time,  the  skin  wound  being  healed  in  seven  days.  Two 
weeks  from  the  day  of  first  operation,  a  second  operation  was  done. 
The  dog  recovered  from  the  anaesthetic  promptly  but  the  second 
day  following,  he  began  chewing  at  his  wound  and  later  he  chewed 
an  extensive  area  over  each  hind  leg.     These  wounds  immediately 


80  R.    W.    LOCHER 

became  infected  to  such  an  extent  that  I  ordered  the  dog  killed 
seven  days  from  the  date  of  second  operation.  At  autopsy,  explora- 
tion of  the  abdominal  cavity  showed  it  to  be  entirely  free  from  peri- 
toneal infection. 

The  second  case  was  a  dog  in  which  a  nephrectomy  had  been 
done  two  weeks  previous.  At  the  second  operation,  a  posterior 
gastro-enterostomy  was  done,  but  the  dog  died  early  the  following 
day.  At  autopsy,  it  was  found  that  death  was  due  to  hemorrhage 
from  the  line  of  anastomosis. 

The  third  death  was  a  dog  which  had  had  a  nephrectomy  done 
four  weeks  previous.  At  the  second  operation,  an  appendectomy, 
was  done;  the  day  following,  the  dog  appeared  listless  and  at  times 
semi-comatose.  As  the  next  day  was  the  beginning  of  Easter  holi- 
days, none  of  the  students  were  present  to  note  the  dog's  condition. 
The  attendant  stated  that  the  dog  died  early  that  morning,  and 
as  the  odor  of  the  dog  was  most  unpleasant,  he  did  not  think  it 
desirable  to  keep  him  until  the  students  returned  so  he  was  cre- 
mated. Consequently,  no  autopsy  was  held  and  the  exact  cause 
of  death  was  not  determined. 

But  one  case  of  actual  infection  of  the  wound  occurred.  This 
was  a  case  in  which  a  Finney  pyloroplasty  was  done.  In  this  case, 
the  edges  of  the  abdominal  wound  accidentally  came  in  actual 
contact  with  the  incision  in  the  duodenum.  The  entire  abdominal 
wound  external  to  the  peritoneum  broke  down  and  suppurated 
freely  for  several  weeks  and  then  finally  healed. 

I  can  but  acknowledge  the  fact  that  our  entire  course  of  experi- 
ments was  entered  upon  with  considerable  misgivings  as  to  the  final 
results,  in  view  of  the  severity  of  the  tests  anticipated,  yet  we  can- 
not help  but  feel,  in  justice  to  the  method  used,  that  none  of  our 
fatal  results  nor  the  one  case  of  infection  of  the  abdominal  wall  were 
due  to  the  technique  of  preparation.  The  one  dog  which  died 
and  on  which  no  autopsy  was  held,  of  course,  cannot  be  counted 
either  in  support  of  or  against  the  method  used. 

An  antiseptic  solution  which  requires  as  a  maximum  but  one 
minute's  use,  to  sterilize  the  skin,  even  in  view  of  the  presence  of 
perceptible  dirt,  and  yet  produce  no  irritation  of  the  skin,  is  almost 
beyond  our  comprehension,  in  view  of  our  past  knowledge  of  and 
experience  with  antiseptics;  more  especially  is  this  true,  when  j^ou 
consider  that  the  skin  of  an  operative  field  thus  sterihzed  can  appar- 
ently be  freely  handled  during  an  operation  and  that  promiscuous 


STUDY  OF  MCDONALD  S  SOLUTION  AND  ETHER  ANESTHESIA        81 

contact  of  the  skin  by  the  viscera  appears  to  do  no  harm.  Such  has 
been  our  experience  in  the  experimental  work  done  on  dogs,  and  such 
uniform  good  results  have  attended  our  efforts,  even  though  such 
work  was  done  by  inexperienced  students,  we  can  but  feel  that  the 
claims  made  by  those  who  have  used  this  solution  in  their  regular 
routine  work  have  been  fully  substantiated  by  my  work  on  animals 
and  that  in  McDonald's  solution  there  exists  possibilities  in  its  ap- 
plication in  surgical  technique  on  the  human  subject  worthy  of  much 
consideration. 

ETHER  ANESTHESIA  PER  RECTUM 

In  considering  a  subject  such  as  ether,  administered  per  rectum 
for  the  purpose  of  producing  surgical  anesthesia,  the  question  natu- 
rally arises  immediately  as  to  the  proper  mode  of  administration.  In- 
vestigators who  have  worked  at  this  particular  subject,  have  learned 
that  an  oil  solution  of  ether  is  best  borne  by  the  mucous  membrane 
of  the  rectum  and  sigmoid.  Various  tests  as  to  the  strength  of  this 
solution,  have  shown  that  a  solution  containing  75  per  cent  ether 
and  25  per  cent  oil  is  borne  as  well  by  the  mucous  membrane  as  any 
solution  containing  a  smaller  percentage  of  ether.  Either  sweet  oil, 
cotton  seed  oil  or  olive  oil  may  be  used.  It  is  this  solution  which  I 
used  throughout  all  my  experiments. 

For  the  purpose  of  allaying  the  unpleasant  irritating  effects  of 
the  solution  when  first  introduced  into  the  rectum,  most  any  of  the 
ordinary  local  anesthetics  may  be  used  provided  the  proper  dose  is 
given.  The  one  anesthetic  which  our  experience  has  shown  to  be 
satisfactory  is  chloretone.  This  we  give  either  in  an  ordinary  gela- 
tine capsule  or  a  suppository,  using  10  grains  at  a  dose.  The  cap- 
sule or  suppository  should  be  introduced  at  least  one-half  hour  be- 
fore time  for  the  introduction  of  the  ether  solution. 

The  prelhninary  hypodermic  injection  of  morphine  sulphate  prior 
to  the  administration  of  ether  by  inhalation  had  worked  so  well  in 
our  work  on  dogs  in  the  past,  that  when  the  subject  of  administra- 
tion per  rectum  was  contemplated  a  continuance  of  this  step  was 
immediately  adopted.  We  have  found  that  ^  grain  of  morphine  ful- 
fills every  want  for  which  it  is  desired  and  it  is  administered  one- 
half  hour  prior  to  the  administration  of  the  anesthetic.  The  im- 
mediate effect  of  morphine  on  the  dog  is  to  produce  emesis  and  a 
free  evacuation  of  the  lower  bowel.  As  the  morphine  is  injected  at 
the  same  time  that  the  suppository  of  chloretone  is  introduced,  the 


82  R.    W.    LOCHER 

effect  of  the  morphine  on  the  lower  bowel  caused  the  suppository  to 
be  ejected.  In  order  to  avoid  this  complication,  the  following  method 
of  preparation  was  instituted.  About  six  hours  before  the  scheduled 
time  of  operation,  the  dog  was  given  1|  ounces  of  castor  oil.  From 
that  time  on,  he  was  not  permitted  to  take  anything  by  mouth  ex- 
cept water.  The  castor  oil  proves  very  effectual  within  from  thirty 
minutes  to  two  hours.  Three  hours  before  time  for  the  operation  a 
high  soap  and  water  enema  was  given.  What  intestinal  content 
had  escaped  the  action  of  the  castor  oil  was  thoroughly  removed  by 
the  enema.  This  preparation  accomplished  several  results.  First, 
it  completely  cleansed  the  intestinal  tract  thus  putting  the  intestines 
in  prime  condition  for  operative  procedures;  second,  the  sudden 
purgation  following  the  administration  of  morphine  was  absent; 
third,  by  having  the  lower  bowel  completely  freed  of  its  fecal  con- 
tent anesthesia  was  produced  much  more  rapidly,  more  completely 
and  by  much  less  ether  solution. 

Prior  to  the  adoption  of  this  method  of  preparation,  we  were  very 
much  at  sea  as  to  the  quantity  of  ether  solution  necessary,  as  we 
were  unable  to  fix  any  definite  working  standard.  In  some  in- 
stances, a  small  quantity  of  the  solution  would  put  a  large  sized 
dog  to  sleep  and  maintain  him  in  that  condition  throughout  the 
operation;  on  the  other  hand,  a  maximum  quantity  would  fail  to 
put  a  small  sized  dog  to  sleep  sufficiently  for  any  kind  of  operative 
procedure.  These  difficulties  vanished  like  snow  in  summer  time 
and  the  cause  was  brought  to  light  just  as  soon  as  we  adopted  our 
method  of  intestinal  preparation.  The  success  or  failure  of  the  anes- 
thesia was  in  direct  proportion  to  the  quantity  of  fecal  material  in 
the  lower  bowel. 

We  next  proceeded  to  determine  whether  it  was  better  to  intro- 
duce immediately  the  entire  initial  dose  or  to  divide  this  dose  into  a 
number  of  smaller  doses  and  introduce  at  intervals  of  every  five  to 
ten  minutes.  It  did  not  take  very  long  to  determine,  beyond  any 
question,  that  the  full  initial  dose  given  at  one  time  is  by  far  the 
better  plan.  The  length  of  time  necessary  to  produce  surgical  anes- 
thesia was  diminished  from  twenty  to  fifty  minutes,  and  as  a  matter 
of  fact,  in  but  very  few  cases,  where  fractional  doses  were  given, 
was  true  surgical  anesthesia  ever  produced. 

To  determine  the  average  initial  dose,  we  experimented  with  var}^- 
ing  quantities  of  the  solution,  ranging  all  the  way  from  |  ounce  to 
6  ounces.     As  the  result  of  this,  we  obtained  all  degrees  of  anesthesia. 


STUDY  OF  Mcdonald's  solution  and  ether  anesthesia      83 

After  testing  and  retesting  the  various  quantities,  taking  into  con- 
sideration the  size  of  the  dog,  we  found  that  for  a  dog  ranging  from 
10  to  13  pounds  in  weight,  1|  ounces  of  the  solution  was  the  proper 
quantity. 

One  problem  we  early  encountered  was  the  difficulty  in  retaining 
the  ether  solution  within  the  rectum  after  the  dog  was  partially 
anesthetized.  The  ether  was  introduced  through  a  rubber  catheter, 
but  as  soon  as  anesthesia  asserted  itself,  the  anal  sphincter  relaxed 
and  the  ether  would  then  flow  out  along  side  of  the  catheter.  To 
obviate  this  state  of  affairs,  large  sized  corks  were  secured  and  per- 
forated sufficiently  to  permit  of  a  close  passage  of  the  catheter. 
Then  on  the  circumference  of  the  cork,  at  a  level  corresponding  in 
size  to  the  maximum  dilatation  of  the  anal  sphincter,  a  flanged 
groove  was  cut.  As  the  dog's  sphincter  relaxed,  the  cork  was 
gently  pushed  into  the  rectum  until  the  sphincter  impinged  around 
the  flange  and  the  cork  would  then  be  held  in  place  without  further 
fear  of  it  dropping  out.  The  lumen  of  that  portion  of  the  catheter 
outside  the  rectum  was  closed  by  a  suitable  clamp.  By  this  method, 
the  ether  solution  could  be  retained  within  the  rectum  as  long  as 
desired. 

The  ether  solution  was  always  introduced  by  the  gravity  method. 
Usually,  by  elevating  the  dog's  pelvis,  sufficient  force  was  present 
to  permit  of  the  introduction  without  difficulty. 

The  length  of  time  required  to  secure  complete  surgical  anesthesia 
was  somewhat  variable  and  corresponded  very  much  to  the  irregu- 
larities seen  in  ether  inhalation  in  human  subjects.  The  average 
time,  taking  all  cases  was  about  forty  minutes.  Within  five  minutes 
following  the  introduction  of  the  ether  into  the  rectum,  the  odor  of 
ether  is  noticeable  on  the  dog's  breath. 

The  only  differences  noted  between  a  dog  being  anesthetized  by  the 
inhalation  method  and  one  on  whom  the  rectal  method  was  used 
were  that  by  the  rectal  method,  there  apparently  was  no  stage  of 
excitement  and  anesthesia  was  much  slower  in  supervening. 

In  order  to  test  the  length  of  time  that  the  initial  dose  remained 
effectual,  extensive  operations  were  undertaken,  and  as  they  were 
done  by  students  with  very  little  experience,  we  had  ample  oppor- 
tunity to  study  this  phase  of  the  subject.  The  initial  dose  remained 
active  on  an  average  of  two  and  a  half  hours.  If,  during  the  course 
of  the  operation,  it  was  seen  that  the  anesthetic  would  be  needed  for 
a  longer  period  of  time  than  that  furnished  by  the  initial  dose  of 


84  R.    W.    LOCHER 

ether,    an    additional  ^  ounce    of   the  solution    was   immediately 
introduced. 

As  the  close  of  the  operation  approached,  usually  at  the  point  of 
closure  of  the  peritoneal  cavity,  the  clamp  on  the  catheter  was  re- 
moved and  the  remaining  portion  of  the  ether  solution  within  the 
rectum  was  allowed  to  escape.  The  dog  usually  showed  evidences 
of  return  to  consciousness  within  fifteen  minutes.  At  the  close  of 
the  operation,  the  rectum  was  thoroughly  irrigated  with  a  solution 
of  warm  water  for  the  purpose  of  removing  the  last  trace  of  the 
ether  solution. 

In  so  far  as  the  post-operative  condition  of  the  rectum  was  con- 
cerned the  results  have  been  rather  astonishing.  Even  in  view  of 
the  fact  that  in  quite  a  number  of  our  animals,  we  used  much  larger 
quantities  of  the  ether  solution  than  was  necessary,  as  our  more 
recent  experience  has  proven,  yet  in  not  a  -single  case,  as  far  as  we 
were  able  to  observe,  was  there  any  evidence  of  a  proctitis  or  of 
diarrhoea. 

Of  all  the  cases  used  in  our  experiments,  we  had  but  one  death, 
which  death  was  undoubtedly  due  to  an  overdose  of  the  anesthetic. 
It  served  as  an  excellent  illustration  of  the  fact  that  ether  anesthesia 
per  rectum  cannot  be  controlled,  in  the  face  of  approaching  catas- 
trophy,  as  easily  as  by  the  inhalation  method.  In  this  particular 
case,  6  ounces  of  the  solution  had  been  introduced  as  the  initial  dose. 
The  student  giving  the  anesthetic  was  inexperienced  in  the  conduct 
of  any  anesthesia  so  failed  to  recognize  the  symptoms  of  approaching 
trouble  until  too  late. 

Even  though  our  fatahties  nimibered  but  one,  a  number  of  our 
cases  more  than  reached  the  danger  line,  due  to  over  dosage,  but 
were  prevented  we  feel,  from  continuing  on  to  a  fatal  termination 
by  the  prompt  withdrawal  of  the  ether  and  in  several  cases  of 
promptly  washing  the  lower  bowel  with  warm  water.  This  danger 
was,  of  course  reduced  to  a  minimum,  when  we  had  learned  the  av- 
erage initial  dose  of  a  dog  of  a  certain  weight.  From  that  time  on, 
we  have  enjoyed  quite  smooth  sailing  in  practically  all  of  our  cases, 
regardless  of  the  type  of  operation. 

One  important  advantage  of  an  anesthetic  given  per  rectum  is 
obvious,  namely  the  absence  of  the  anesthetist  and  his  parapher- 
nalia; especially,  is  this  true  of  those  operations  in  the  region  of  the 
head  and  neck.  The  total  quantity  of  ether  actually  used  to  pro- 
duce a  certain  degree  of  anesthesia  is  much  less,  and  furthermore, 


STUDY  OF  Mcdonald's  solution  and  ether  anesthesia      85 

the  unpleasant  incidences  such  as  choking  with  mucus,  swallowing 
of  the  tongue  and  aspiration  pneumonia  are  seen  much  less  fre- 
quently, yet  this  form  of  anesthesia,  we  feel,  from  our  experience, 
has  certain  disadvantages.  In  order  to  properly  administer  ether 
per  rectum,  the  anesthetist  must  be  thoroughly  experienced  in  this 
particular  kind  of  anesthesia,  he  must  be  present  for  a  considerable 
period  of  time  prior  to  the  operation  in  order  to  have  his  patient 
ready  for  the  surgeon  at  the  proper  time;  he  must  keep  a  much  more 
careful  watch  on  his  patient  in  order  to  observe  the  first  evidence  of 
an  over-dose,  and  last,  and  by  far  the  most  important,  the  inability 
to  secure  as  prompt  response  to  emergency  measures  as  in  those 
cases  in  which  the  anesthesia  has  been  given  by  inhalation. 

Granting  all  of  these  disadvantages,  it  is  our  opinion  that  ether  anes- 
thesia per  rectum  fills  a  certain  long  felt  want  in  certain  types  of  cases 
and  operations,  and  as  its  behavior  under  various  conditions  comes  to 
be  better  understood,  its  adoption  will,  in  all  probability,  be  more 
general  and  its  range  of  usefulness  materially  increased.  Thus  far, 
our  experience  with  this  method  in  the  human  subject  has  been 
without  serious  complication  and  added  much  to  the  facility  of  sur- 
gical procedures  in  the  type  of  cases  to  which  we  have  applied  it. 


BULLETIN 

OF    THE 

University  of  Maryland  School  of  Medicine 

AND 

College  of  Physicians  and  Surgeons 


Publication  Committee 

Randolph  Winslow,  A.M.,  M.D.,  LL.D.  Wm.  S.  Gakdner,  M.D. 

J.  M.  H.  RowxAND,  M.D. 

Nathan  Winslow,  A.M.,  M.D.,  Editor 

Associate  Editors 

Albert  H.  Carboll,  M.D.  Andrew  C.  Gillib,  A.M.,  M.D. 

John  Evans,  M.D. 


Death  of  Dr.  Louis  McLane  Tiffany 

The  years  1915  and  1916  have  become  memorable  in  the  annals 
of  the  University  of  Maryland  on  account  of  the  repeated  visits 
of  the  grim  reaper,  who  has  cut  down  so  many  of  our  most  loved 
and  honored  colleagues.  We  are  again  called  upon  to  announce 
the  death  of  one  of  the  most  distinguished  and  revered  men  who 
have  ever  held  professional  chairs  in  the  Faculty  of  Physic,  Louis 
McLane  Tiffany,  A.M.,  M.D.,  ex-professor  of  surgery.  Dr.  Tiffany 
was  born  in  Baltimore  and  except  during  the  time  he  was  in  resi- 
dence at  Cambridge  University,  England,  this .  city  was  his  home. 
Graduating  at  the  University  of  Maryland  in  1868  he  settled  at  once 
into  practice  but  soon  began  to  specialize  in  surgery.  From  1869- 
1874  he  was  demonstrator  of  anatomy;  from  1874-1881  professor 
of  operative  surgery  and  from  1881-1902  he  was  professor  of  sur- 
gery. In  1902  he  resigned  his  chair  and  soon  thereafter  retired 
from  the  practice  of  his  profession.  A  more  graceful  pen  than 
that  of  the  writer  will  pay  fitting  tribute  to  the  memory  of  our 
eminent  friend  and  colleague  but  we  wish  to  place  on  record  our 
appreciation  of  the  many  qualities  of  heart  and  mind  that  placed 
him  upon  an  elevation  high  above  his  fellows.  Tall,  dignified  and 
handsome  he  was  a  marked  man  in  any  company;  urbane  and  pol- 
ished in  manner  he  was  a  delightful  companion;  keen  and  satirical 
in  dispute  he  was  an  opponent  to  be  dreaded.  With  a  mind  of  ex- 
ceptional acuity  and  with  perseverance  and  great  industry  he  solved 
difficult  problems  of  surgery,  developed  an  almost  unerring  judgment 
and  attained  an  enviable  fame  as  a  skillful  surgeon. 

86 


EDITORIALS  87 

The  following  memorial  was  ordered  to  be  spread  on  the  min- 
utes of  the  Faculty  of  Physic  and  to  be  conveyed  to  the  family  of 
Dr.  Tiffany. 

Whereas,  in  God's  providence,  by  the  death  of  Louis  McLane  Tiffany  the 
community  has  lost  a  conspicuous  and  valuable  citizen,  the  medical  profes- 
sion a  distinguished  teacher  and  surgeon,  and  his  many  friends,  even  in  the 
years  of  his  inactivity,  a  wise  and  kindly  counsellor,  the  Faculty  of  Physic  of 
the  University  of  Maryland,  in  recognition  of  his  character,  desire  to  record 
this  evidence  of  appreciation  and  admiration. 

As  professor  of  surgery  in  the  university  for  many  years,  possessor  of  rare 
surgical  judgment  and  skill  and  controlled  in  everj^  action  by  the  highest 
ideals.  Dr.  Tiffany  exerted  on  hosts  of  men  a  compelling  and  helpful  influence. 

To  the  alumni  of  the  university  scattered  throughout  the  country  Dr.  Tif- 
fany's death  will  bring  keen  regret  and  sorrow,  and  they,  as  well  as  the  pres- 
ent members  of  the  faculty,  will  wish  to  extend  to  his  family  a  heartfelt 
sjonpathy  in  their  affliction. 

J.  M.  H.  Rowland, 

Dean. 

The  Session  1916-1917 

The  matriculation  books  have  now  been  closed  and  we  are  able 
to  announce  the  number  of  students  enrolled.  Freshman  87, 
sophomores  52,  juniors  64,  seniors  106,  total  309. 

This  is  a  very  satisfactory  showing  and  we  are  especially  pleased 
at  the  large  freshman  class.  We  would  have  been  quite  satisfied 
with  an  enrollment  of  60  freshmen  and  the  large  increase  is  both 
gratifying  and  unexpected.  A  considerable  number  of  new  men 
also  entered  the  sophomore  and  junior  classes  so  that  notwithstand- 
ing the  large  percentage  of  deficient  students  dropped  from  these 
classes  their  numbers  remain  about  the  same  as  those  of  last  year. 

The  work  of  the  session  is  progressing  smoothly;  the  division  of  the 
senior  class  into  three  sections  for  clinical  instruction  at  the  Mercy, 
Maryland  General  and  University  Hospitals  enables  us  to  utilize 
our  immense  clinical  materia)  to  good  advantage.  These  sections 
rotate  every  ten  weeks,  and  the  sections  assigned  to  the  Uinversity 
Hospital  are  required  to  be  in  residence  at  the  hospital.  In  this 
manner  every  man  is  an  interne  at  least  two  and  a  half  months 
before  graduation  and  some  for  a  longer  period.  For  about  fifty 
years  there  has  been  a  voluntary  clinical  assistant  system  at  th^ 
University  Hospital,  for  which  those  ''house  students,"  as  they  were 
called,  paid  an  extra  fee.  This  has  now  been  done  away  with  and 
all  seniors  are  required  to  serve  as  clinical  assistants  for  ten  weeks 
without  additional  charge. 


EDITORIALS 


The  Mayo  Foundation 


We  announce  with  mingled  pleasure  and  regret  the  appointment 
of  Dr.  Fred  Rankin,  assistant  demonstrator  of  anatomy,  and  asso- 
ciate in  surgery,  to  a  fellowship  in  surgery  on  the  Mayo  Founda- 
tion, Rochester,  Minnesota.  This  involves  a  three  years'  course 
of  instruction  at  St.  Paul  and  Rochester,  at  the  end  of  which  the 
degree  of  Doctor  of  Science  is  conferred  by  the  University  of  Minne- 
sota. This  offers  a  great  opportunity  for  any  bright  and  diligent 
man  and  we  are  sure  that  Dr.  Rankin  will  fill  the  bill  in  every  par- 
ticular. He  will  not  be  the  only  University  of  Maryland  man, 
however,  at  the  Mayo  Clinic,  as  Dr.  P.  P.  Vinson  has  also  received 
an  appointment  in  pathology  and  medicine  and  Dr.  E.  B.  Quillen 
is  also  doing  post-graduate  work  of  some  kind  there.  Dr.  H.  C. 
Irwin  has  finished  his  service  as  an  assistant  at  the  clinic  and  is  now 
in  France.  All  these  are  young  men  of  ability  and  of  great  promise 
and  we  believe  they  will  do  themselves  and  the  University  credit. 

Dr.  Joseph  Irwin  France 

Dr.  Joseph  Irwin  France,  College  of  Physicians  and  Surgeons, 
1903,  was  elected  United  States  Senator  from  Maryland  on  Novem- 
ber 7.  He  is  forty-three  years  old  and  is  a  son  of  the  Rev.  Dr.  Joseph 
Henry  France,  a  Presbyterian  minister  now  living  at  Naples,  New 
York.  Dr.  France  is  a  Marylander,  one  of  his  ancestors  having 
come  from  England  and  located  in  Baltimore  long  before  the  Revo- 
lutionary War.  At  the  age  of  twenty-one  he  was  graduated  from 
Hamilton  College,  Clinton,  New  York,  and  was  awarded  the  Elihu 
Root  foreign  fellowship  in  physical  science  at  the  same  time  he  was 
given  a  graduate  scholarship  in  anatomy  and  physiology  at  Cornell 
University.  Later  he  went  abroad  and  continued  his  studies  at 
the  University  of  Leipzig.  Returning  to  this  country  he  took  a 
course  at  Clark  University  and  was  then  called  to  the  chair  of  natural 
science  at  the  Jacob  Tome  Institute  at  Port  Deposit,  Maryland. 
In  1903  he  took  his  degree  in  medicine  and  the  same  year  he  mar- 
ried Mrs.  Evelyn  S.  Tome,  widow  of  Jacob  Tome. 

He  first  became  interested  in  politics  in  1905,  when  he  was  nomi- 
uated  by  the  Republican  party  of  Cecil  County  for  state  senator. 
The  Democratic  nominee  at  that  time  was  the  late  Austin  L.  Crothers, 
afterward  governor  of  Maryland.  Dr.  France  was  elected  to  the 
state  senate  by  a  majority  of  over  four  hundred.  His  record  in 
the  state  senate  was  commendable  and  received  the  indorsement 


EDITORIALS  89 

of  the  independent  press.  He  was  an  earnest  advocate  of  greater 
publicity  for  legislative  procedure  and  for  economy  in  the  transac- 
tion of  the  state's  business. 

In  January  1916  he  succeeded  Dr.  John  Ruhrah  as  secretary  of 
the  Medical  and  Chirurgical  Faculty  of  the  state  of  Maryland. 

Dr.  France  has  no  idea  of  taking  his  new  office  in  any  way  but  as 
an  opportunity  to  be  of  some  service  to  the  country.  He  has  for 
many  years  been  closely  associated  with  the  business  men  of  the 
community  and  is  familiar  with  their  problems,  and  with  the  in- 
fluence that  federal  legislation  has  upon  them. 


1 

""v 

1 

H  |||||ywf^^~  ^  f^^ 

ZLisL^ 

R     ^v  ^  J 

• 

^B        ^     ^Sh 

K 

^  ""^  .^^^^ 

3 

1 

■ 

p 

1 

1 

1 

He  is  very  deeply  interested  in  public  health  questions  and  hopes 
to  see  a  national  health  bureau  established  that  will  be  in  keeping 
with  the  greatness  of  the  country  and  the  needs  of  the  people. 

It  is  recognized  that  the  organization  of  an  efficient  public  health 
bureau  can  not  be  effected  in  a  day,  but  with  six  years  of  earnest 
work,  and  with  the  assistance  of  the  medical  profession  much  can 
be  accomplished. 

Graduates  of  the  Baltimore  Medical  College 

The  Dean's  office  recently  received  a  communication  from  an 
alumnus  of  the  Baltimore  Medical  College,  who  stated  that  it 
would  be  a  great  convenience  to  him  in  filling  out  an  application 


90  EDITORIALS 

blank  to  designate  himself  as  an  alumnus  of  the  University  of 
Maryland.  He  wished  to  know  if  he  would  be  justified  in  so  doing, 
and  what  would  be  the  correct  procedure.  As  similar  questions 
may  arise  from  time  to  time,  it  seems  opportune  to  publish  the  form 
that  should  be  followed  in  such  cases:  i.e.,  John  Doeberry,  M.D. 
1898,  University  of  Maryland  (Baltimore  Medical  College).  This 
has  the  sanction  of  the  American  College  of  Surgeons.  It  might 
be  well  to  add  that  the  certificates  issued  to  the  graduates  of  the 
Baltimore  Medical  College  by  the  University  of  Maryland  may 
still  be  had  for  ten  dollars  by  applying  to  the  Registrar.  The  cer- 
tificate is  engrossed  on  parchment  and  presents  an  attractive, 
dignified  appearance. 

To  Explore  Upper  Amazon 

Dr.  William  T.  Councilman,  of  Harvard  University,  is  leaving 
Boston  this  week  with  the  expedition  which  is  going  up  the  Amazon 
and  Rio  Negro  rivers,  in  South  America. 

The  expedition  is  provided  by  Dr.  Rice,  and  its  mission  is  geo- 
graphical and  topographical.  It  aims  to  make  a  survey  of  a  very 
interesting  region  about  which  very  little  is  known. 

The  party  will  leave  on  the  steam  yacht  Alberta,  which  formerly 
belonged  to  the  King  of  Belgium.  This  will  carry  them  1800  miles 
into  the  river  region.  There  they  wiU  leave  the  yacht  as  a  base,  and 
take  to  launches  and  boats. 

Dr.  Councilman,  who  is  going  to  study  the  human  and  animal 
diseases  of  the  region,  is  a  son  of  the  late  Dr.  John  T.  Councilman, 
of  Baltunore  County. 

STATEMENT  OF  THE  OWNERSHIP,  MANAGEMENT,  CIRCULATION, 

ETC.,  REQUIRED  BY  THE  ACT  OF  CONGRESS  OF 

AUGUST  24,  1912, 

Bulletin   of    University    of   Maryland   School   of   Medicine   and  College  of 

Physicians  and  Surgeons,  published  ten  times  per  annum  at  Baltimore, 

Md.,  for  October  1,  1916. 
Name  of  Editor,    Nathan  Winslow,   M.D.,    Calvert   and  Saratoga  Streets, 

Baltimore,  Md. 
Managing  Editor,  None. 
Business  Managers,  Randolph  Winslow,  M.D.,  J.  M.  H.  Rowland,  M.D.,  and 

W.  S.  Gardner,  M.D.,  Lombard  and  Greene  Streets,  Baltimore,  Md. 
Publisher,  The  University  of  Maryland  School  of  Medicine  and  College  of 

Physicians  and  Surgeons,  Calvert  and  Saratoga  Streets,  Baltimore,  Md. 


ITEMS  91 

Owner,  The  University  of  Maryland  School  of  Medicine  and  College  of  Phy- 
sicians and  Surgeons,  Calvert  and  Saratoga  Streets,  Baltimore,  Md. 

Known  bondholder,  mortgagees,  and  other  security  holders,  holding  1  per 
cent  or  more  of  total  amount  of  bonds,  mortages,  or  other  securities. 
(If  there  are  none,  so  state.)     None. 

Nathan  Winslow,  M.D. 

Sworn  to  and  subscribed  before  me  this  20th  day  of  September,  1916. 

[seal]  Mary  Virginia  Ward,  Notary  Public. 

(My  commission  expires  May  1,  1918.) 

ITEMS 

The  regular  monthly  meeting  of  the  Mercy  Hospital  House  Staff 
Medical  Society  took  place  on  October  26  in  the  College  of  Physi- 
cians and  Surgeons  Imilding. 

Many  of  the  faculty  and  seniors  were  present  and  entered  into 
the  discussion  of  cases.  Interesting  papers  were  read  by  Drs. 
Mayer,  Chaput,  McLean,  and  Post. 

Meetings  will  be  held  each  month,  November  23,  1916  being  the 
next  date. 

Dr.  Ross  Anderson,  C.  P.  &  S.  '05,  Salt  Lake  City,  Utah,  is  now 
in  Baltimore  following  the  clinics. 

Dr.  Vivian  H.  Vandeventer,  C.  P.  &  S.,  '96,  Ishpeming,  Mich., 
spent  the  first  two  weeks  of  October  in  Baltimore. 

Dr.  Gordon  Wilson  will  represent  the  University  at  the  meeting 
of  the  Southern  Medical  Society  in  Atlanta,  Ga.,  November  13, 
1916.  Dr.  Alexius  McGlannan  will  read  a  paper  on  "Empyema," 
before  the  surgical  section  of  this  society  at  the  same  meeting. 

Dr.  Percy  J.  McElrath,  C.  P.  &  S.,  '93,  Branwell,  W.  Va.,  spent 
the  past  week  in  Baltimore. 

Dr.  Thos.  F.  E.  Bess,  C.  P.  &  S.,  '14,  Hinton,  W.  Va.,  has  been 
spending  a  few  days  in  Baltimore. 

Dr.  Alexius  McGlannan,  C.  P.  &  S.,  '95,  gave  an  address  before 
the  Clinical  Society  of  Surgery,  on  the  subject  of  "Fracture  of  the 


92  DEATHS 

Neck  of  Femur,"  October  20.     Dr.  Max  Kahn,  C.  P.  &  S.,  '05, 
gave  an  X-Ray  demonstration  at  the  same  meeting. 

Dr.  Chas.  W.  Maxson,  C.  P.  &  S.,  '10,  Steubensville,  Ohio,  spent 
the  last  couple  weeks  in  Baltimore. 

Dr.  F.  E.  Henry,  Vandegrift,  Pa.,  P.  &  S.,  '91,  is  taking  a  special 
course  in  the  Medical  School. 

Dr.  Robt.  B.  Garland,  P.  &  S.,  '13,  Hartford,  Conn.,  has  been 
appointed  Police  Surgeon  of  Hartford,  Conn. 

Dr.  Herbert  L.  Langer,  C.  P.  &  S.  '14,  former  resident  physician, 
Bellevue  Hospital,  New  York,  has  opened  an  office  in  Brooklyn, 
where  he  will  practice  medicme  and  surgery. 

Dr.  M.  A.  Thomson,  U.  of  M.  '80,  Anderson,  S.  C,  was  a  recent 
visitor  at  the  University. 

Drs.  E.  F.  Gott  and  F.  P.  Weltner,  C.  P.  &  S.  '15,  former  resi- 
dents of  Mercy  Hospital,  have  opened  an  office  in  Bluefield,  W.  Va. 
Dr.  Gott  will  specialize  in  surgery  and  Dr.  Weltner  in  medicine 
and  children. 

DEATHS 

George  Hauer  Everhart,  M.D.,  Baltimore,  U.  of  M.,  Baltimore, 
'90;  aged  55;  chief  surgeon  and  medical  director  of  the  Skin  and 
Cancer  Hospital,  Baltimore,  since  its  foundation;  died  at  his  home, 
September  17.  It  was  announced  at  his  funeral  that  the  Skin  and 
Cancer  Hospital  would  in  the  future  be  known  as  the  Everhart 
Skin  and  Cancer  Hospital. 

Robert  Wm.  Crawford,  M.D.,  Strasburg,  Va.,  U.  of  M.,  Balti- 
more, '06;  aged  36;  chief  surgeon  of  the  Atlantic  Coast  Line  Rail- 
way, with  headquarters  at  Wilmington,  N.  C,  died  at  his  home, 
September  21. 

Louis  L.  Lloyd,  M.D.,  B.  M.  C,  '04;  aged  46,  died  in  the  Maryland 
General  Hospital,  Baltimore,  September  29,  from  diseases  of  the 
intestine. 


BOOK   REVIEWS  93 

Emmet  Alvin  Walsh,  M.D.,  Shreveport,  La.;  U.  of  M.,  '87;  aged 
52;  a  Fellow  of  the  American  Medical  Association;  pathologist  and 
assistant  superintendent  of  the  State  Charity  Hospital;  Shreve- 
port; died  October  6  after  an  operation  for  acute  appendicitis. 

George  Bayloss  Stilhnan,  M.D.,  East  Cleveland,  Ohio,  C.  P.  & 
S.,  Baltimore,  '80;  aged  64;  formerly  a  member  of  the  Ohio  State 
Medical  Association;  died  in  Buffalo,  October  12. 

Aristide  W.  Giampietro,  M.D.,  Tampa,  Fla.,  U.  of  M.,  Balti- 
more, '07;  aged  34;  a  member  of  the  American  Chemical  Society; 
died  in  the  Gordon  Keller  Hospital,  Tampa,  August  30  from 
pneumonia. 

BOOK  REVIEWS 

Obstetrics:  Normal  and  Operative.  By  George  Peaslee  Shears, 
B.S.,  M.D.,  Professor  of  Obstetrics  and  Attending  Obstetrician 
at  the  New  York  Polyclinic  Medical  School  and  Hospital; 
formerly  Instructor  in  Obstetrics,  Cornell  University  Medical 
College;  Attending  Obstetrician  at  the  New  York  City  Hospi- 
tal; Senior  Attending  Obstetrician  at  the  Misericordia  Hos- 
pital. 419  Illustrations.  1916.  Cloth,  $6.00  net.  Philadel- 
phia and  London:  J.  B.  Lippincott  Company. 

The  student  and  practicing  physician  should  find  this  book  ad- 
mirably suited  to  their  needs.  Much  of  the  irrelevant  matter  found 
in  the  text  books  on  obstetrics  extant  is  deleted  in  this  work,  the 
author  only  giving  space  and  attention  to  those  subjects  which  are 
of  practical  import  in  the  practice  of  the  art  of  midwifery,  for  in- 
stance the  section  on  embryology  which  is  found  in  most  text  books 
is  left  untouched  in  this.  Surely  this  is  an  advance  step,  and  a  move 
in  the  right  direction  for  embryology  is  a  science  in  itself  and  can- 
not be  properly  treated  in  a  generrl  book  on  obstetrics.  It  is  well 
illustrated,  and  full  of  practical  suggestions,  derived  from  a  large 
practical  experience  by  the  author.  With  briefness  almost  terse- 
ness, the  author  touches  on  the  theory  of  obstetrics,  but  with  suffi- 
cient fullness  to  enable  the  student  to  grasp  fully  the  essentials 
underlying  the  art  of  child-bearing.  It  gives  us  great  pleasure  to 
recommend  it  to  our  readers,  believing  that  they  will  find  in  it  a 
trustworthy  guide. 


94  BOOK    REVIEWS 

International  Clinics.  Edited  by  H.  R.  M.  Landis,  Philadelphia. 
Vol.  1.  Twenty-Sixth  Series.  1916.  Philadelphia  and  Lon- 
don: J.  B.  Lippincott  Company.     Cloth,  $2.00  net. 

In  this  volume  are  a  number  of  very  interesting  and  instructive 
articles  by  leaders  of  the  profession,  but  those  which  should  particu- 
larly appeal  to  the  readers  of  the  Bulletin  are  "Drug  Therapy  in 
Cardiovascular  Diseases,"  by  Thomas  E.  Satterthwaite,  M.D., 
LL.D.,  Sc.D.,  and  "On  the  Early  Diagnosis  of  Gastric  Cancer," 
by  Julius  Friedenwald,  M.D.,  both  alumni  of  the  University  of 
Maryland.  Doctor  Satterthwaite  says,  "In  the  treatment  of  car- 
diovascular diseases  certain  facts  should  be  kept  constantly  in 
mind.  One  of  these  is  that  the  heart's  efficiency  is  conditioned  on 
the  phj^siological  action  of  its  walls,  valves,  vessels  and  nerves. 
Deviation  from  the  normal  in  any  one  of  these,  whether  in  texture 
or  in  function,  induces  corresponding  changes  in  clinical  signs,  and 
means  disease.  Single  lesions  are  very  rare,  while  multiple  defects 
are  frequent.  Endocardiopathies  illustrate  this  point.  An  individ- 
ual is  said  to  have  aortic  or  mitral  stenosis,  either  of  which  may 
be  the  principal  fault,  and  yet  two  or  more  valves  are  usually 
implicated.  The  danger  from  valve  disease  is  comparatively  slight, 
so  far  as  the  valve  is  concerned,  but  very  great  from  the  attend- 
ant changes  that  precede  compensation  and  follow  decompensation. 
It  is  the  rule,  too,  that  there  are  systemic  toxemias  underlying 
both  acute  and  chronic  diseases,  both  of  the  endocardium  and  the 
myocardimn.  Obviously,  then  these  subordinate  systemic  intoxi- 
cations should  be  recognized  at  their  true  importance  if  the  dis- 
ease is  to  be  cured  or  checked."  He  then  discusses  in  turn  the 
cardiac  stimulants,  vasomotor  drugs,  cardiac  sedatives,  and  laxa- 
tives, with  their  uses,  contraindications  and  abuses.  In  anatyzing 
a  series  of  1000  cases  occmi'ing  in  his  practice,  Friedenwald  states 
that  there  was  a  history  of  some  previous  gastric  trouble  in  but 
232  (23.2  per  cent).  Of  the  232  cases,  109  had  shght  attacks  of 
indigestion  for  a  period  of  five  years  or  more  preceding  the  present 
gastric  disease,  while  25  had  slight  attacks  only  during  the  five  years 
preceding  the  present  disease.  Of  the  remaining  123  cases,  32  had 
chronic  indigestion  more  or  less  all  their  lives,  of  which  29  had 
chronic  indigestion  mainly  during  the  five  years  preceding  the 
present  illness.  Seventy-three  cases  gave  a  definite  history  of  for- 
mer gastric  ulcer.  It  is  therefore  evident  that  of  these  1000  cases, 
but  23  per  cent  presented  histories  of  previous  gastric  digestive 


BOOK   REVIEWS  95 

disturbances,  even  in  the  slightest  degree,  and  that  but  7.3  per  cent 
gave  direct  histories  of  ulcer,  while  in  77  per  cent  of  the  cases  the 
onset  was  sudden  and  acute.  In  the  arriving  at  an  early  diagnosis 
he  places  much  dependence  in  these  signs. 

1.  Loss  of  weight. 

2.  Pain. 

3.  Anorexia. 

4.  Vomiting. 

5.  Dysphagia. 

6.  Hematemesis. 

7.  Helena  and  the  presence  of  occult  blood  in  the  stools. 

8.  Dilatation  of  the  stomach. 

9.  The  presence  of  a  palpable  tumor. 

10.  Ascites  and  edema  of  the  extremities. 

11.  Changes  in  the  gastric  secretion. 

12.  Serodiagnosis. 

13.  Certain  roentgenological  findings. 

He  says  surgerj^  to  offer  any  hope  of  success  must  be  resorted  to 
early,  and  as  our  means  of  early  diagnosis  are  exceedingly  insuffi- 
cient, and  until  more  certain  methods  of  diagnosis  are  available, 
exploratory  incisions  should  be  urged  upon  all  individuals  over 
forty  years  of  age  having  gastric  symptoms  which  are  not  relieved 
after  a  few  weeks  of  treatment.  Especially  is  this  the  case  if  the 
patient  presents  a  history  of  rather  abrupt  onset,  some  loss  of  flesh, 
an  absence  of  free  hydrochloric  acid  and  occult  blood  in  the  stools. 

International  Clinics.     Edited  by  H.  R.  M.  Landis,  M.D.,  Phila- 
delphia,   U,    S.    A.     Volume    11.     Twenty-Sixth   Series,  1916. 
Philadelphia  and  London:  J.  B.  Lippincott  Company.     Cloth, 
$2.00  net. 
That  the  profession  is  awakening  to  the  use  of  bleeding  is  attested 
by  numerous  articles  which  are  making  their  appearance  in  the  jour- 
nals on  this  subject,  even  the  International  Clinics  is  emphasizing 
the  benefits  to  be  derived  from  venesection  by  inaugm'ating  Volume 
11,  twenty-sixth  series  with  an  article  by  E.  J.  G.  Beardsley,  M.D., 
assistant  professor  -of  clinical  medicine,  Jefferson  Medical  College, 
entitled  "The  Indications  for  Venesection."      In  this  article  the 
author  states:  It  is  probable  that  no  single  treatment,  other  than 
drug  therapy  has  been  more  widely  practiced  in  the  past  and  in  all 
parts  of  the  world.    He  then  enumerates  five  chief  reasons  why  vene- 
section is  so  unpopular  with  the  profession: 


96  BOOK   REVIEWS 

1.  It  is  improperly  employed  at  times. 

2.  Medical  teachers  seldom  perform  venesection  in  their  clinics 
and  their  students  do  not  observe  the  value  of  this  method  of  treat- 
ment during  their  most  impressionable  undergraduate  days. 

3.  There  is  a  tendency  on  the  part  of  the  patient  and  the  patient's 
friends  to  look  upon  this  treatment  as  a  formidable  operation. 

4.  Physicians  who  have  not  used  the  method  personally  are 
likely  to  magnify  the  supposed  difficulties  and  dangers  of  the  opera- 
tion and  be  content  to  administer  drugs  which  are  often  disappoint- 
ing in  their  action  and  certainly  can  never  give  the  prompt  relief 
that  is  experienced  by  the  patient  who  is  properly  bled  for  the 
definite  purpose  of  relieving  a  distended  right  heart. 

5.  The  operation,  unless  properly  prepared  for  and  conducted, 
may  result  in  the  soiling  of  the  patient's  bed  linen  with  blood  and 
thus  prove  an  embarrassment  to  the  phj^sician  as  well  as  cause 
annoyance  to  the  patient  and  household. 

He  then  cites  a  number  of  ills  in  which  he  has  employed  vene- 
section beneficially,  namely:  Acute  alcoholism,  angina  pectoris, 
aneurism,  apoplexy,  arteriosclerosis,  asthma,  bronchitis,  cardiac 
insufficiency,  convulsions,  delirium  tremens,  emphysema,  hyper- 
plesis,  hypertension,  hyperthyroidism,  myocarditis,  nephritis,  parox- 
ysmal tachycardia,  pericarditis,  pneumonia,  polycythemia,  pul- 
monary congestion,  pulmonary  edema,  uremia,  toxemia.  In  each 
disease  in  the  above  list  the  doctor  is  dealing  with  an  overacting 
heart  and  an  embarrassed  heart,  and  that  venesection  which  will 
lessen  the  burden  cannot  but  accomplish  good. 

Medicines  as  such  with  but  few  exceptions  have  proven  lament- 
ably disappointing.  Therefore,  physicians  must  turn  to  physical 
agents  to  help  tide  over  such  crises  as  suppression  of  m'ine,  over- 
distended  right  heart,  etc.  The  potenc}^  of  venesection  was  thor- 
oughly realized  by  our  ancestors,  though  perhaps  employed  inju- 
diciously and  without  a  clear  understanding  of  the  physiologic 
principles  underlying  the  principle  of  blood-letting.  AVithin  recent 
times,  .the  principles  undertying  the  use  of  bleeding  have  been  mas- 
tered, so  that  now  the  procedure  is  rational  and  not  empirical. 
When  used  properly  it  is  an  agent  of  great  value  to  the  physician 
and  Doctor  Beardsley's  article  should  go  a  long  way  towards  re- 
popularizing  an  old  and  proven  friend.  There  are  a  number  of 
other  articles  which  have  more  than  ordinary  merit  and  should 
prove  interesting  to  our  readers. 


URSMMMiOPaa 


\ 


MISS  LOUISA  PARSONS 

SHE    ORGANIZED   THE   TR.UNING   SCHOOL   FOB   NURSES   AT  THE     UNIVERSITY     OF    MARYLAND     AND 
WAS  ITS   FIRST   SUPERINTENDENT. 


BULLETIN 

OF  THE 

University  of  Maryland  School 
OF  Medicine 

AND 

College  of  Physicians  and 
Surgeons 

Successor  to  The  Hospital  Bulletin,  of  the  University  of  Marylanil, 
Baltimore  Medical  College  News,  and  the  Journal  of  the  Alumni  Aaao- 
ciation  of  the  College  of  Physicians  and  Surgeons 

Vol.  I  DECEMBER,   1916  No.  5 

ADDRESS  BY  DR.   RIDGELY  B.   WARFIELD 

Academic  Day,  University  of  Maryland,  November  14, 

1916 

If  "man  makes  beauty  of  that  which  he  loves"^  and  beauty  is 
truth,  "beholding"  with  Milton  "the  bright  countenance  of  truth 
in  the  quiet  and  still  aii-  of  delightful  studies"  may  we  not  her 
guardians  and  sons  especially  on  this  occasion,  her  day  we  cele- 
brate, becomingly  record  our  devotion  to  our  University?  Favored 
educational  institutions  may  arise  speedily  by  the  assembling  of 
brains  and  benefits  of  other  estabHshment.  No  considerable  in- 
stitution can  afford  smugly  to  shut  its  doors  against  accession  of 
external  idea  and  influence,  but  long  and  honorable  existence  is 
accompanied  down  the  years  by  prized  tradition  and  dignity,  real 
assets  to  the  heritors  of  the  present. 

The  University  of  Maryland  is  rich  in  such  heritage.  I  do  not 
care  to  epitomize  her  history  made  available  by  the  talent  and  in- 
dustry of  the  late  Dr.  Cor  dell  but  I  may  be  permitted  to  emphasize 
that  the  University  in  her  present  construction  and  connection 
whatever  her  limitations,  is  the  product  of  the  best  thought  and 
highest  quality  of  service  afforded  by  the  State  for  more  than  an 
hundred  years.     Enrolled  under  her  banners  are  two  of  the  four 

'  Renan. 

97 


98  RIDGELY   B.    WARFIELD 

schools  surviving  a  century's  existence,  St.  Johns  College,  by  affilia- 
tion our  school  of  letters,  and  the  school  of  medicine  upon  which 
the  University  was  founded,  for  a  long  time  her  only  department 
and  now,  with  one  notable  exception,  not  only  the  survivor  but  the 
inheritor  of  all  that  remains  in  Maryland  of  constructive  effort  in 
medical  education. 

Educational  projects  of  every  sort  developed  slowly  in  Maryland, 
as  in  America  generally,  difficulties  were  large  and  often  insurmount- 
able, many  efforts  ended  in  failure.  If  in  the  earty  days*an  insti- 
tution continued  it  was  due  to  peculiar  strength  of  the  instructors 
and  their  successors.  There  was  weakness  too  in  that  skilled  teach- 
ers were  few.  In  the  Colonial  period  and  reaching  down  to  the  last 
centmy  instruction,  although  fair  in  outline,  was  frequentl}^  under- 
taken by  men  of  little  worth,  often  by  adventurers  or  wanderers 
and  sometimes  by  those  who  had  left  theii*  countrj'-  for  their  country's 
good.  Still  in  the  main  development  of  character  was  the  chief 
concern  with  direction  moral  as  well  as  intellectual  and  fruitful  if 
measured  by  results,  for  then  as  always  strong  men  arose  in  the 
land. 

It  has  been  observed  that  advanced  instruction  in  early  American 
colleges  was  for  the  most  part  designed  to  meet  the  needs  of  those 
training  for  the  priesthood  or  ministry.  Man}-^  pioneer  colleges 
were  denominational.  St.  Mary's  Catholic  Seminary  in  Baltimore 
has  had  an  unbroken  existence  since  1791,  in  any  event  schools  of 
law  were  nonexistent  until  the  nineteenth  century  and  the  acquire- 
ment of  the  degree  of  Doctor  of  Medicine  was  very  difficult  because 
of  the  paucity  of  schools.  Dr.  Cordell  reminds  us  that  three  of  the 
faculty  designated  b}^  legislation  enacted  in  1807  to  inaugurate  our 
medical  department  were  without  the  degree  of  M.D.  which  was 
nevertheless  poHtely  accorded  them  by  the  assembly.  These  were 
all  men  of  real  abihty  and  for  their  time  learned  practitioners.  Two 
of  them  were  graduates  of  St.  John's,  and  one  the  talented  John 
Shaw,  naval  surgeon,  poet  and  traveler,  was  a  notably  picturesque 
figure  of  his  age.  Admu'able  men  occasionally  practiced  medicine 
without  degree  as  late  as  the  morning  of  our  own  day.  I  have  seen 
in  INIaryland  an  honorable  doctor  who  died  in  1873,  the  beloved 
preceptor  of  numbers  of  students,  and  easily  the  most  conspicuous 
practitioner  in  his  community,  who  was  without  degree  and  whose 
formal  medical  training  was  included  in  one  com'se  of  lectures  in 
this  University.     Medical  education  grew  out  of  the  old  order  of 


ADDRESS  99 

apprenticeship  and  the  controlHng  force  of  personahty  has  been 
perhaps  in  a  way  dissipated  in  modern  tendency.  After  all  knowl- 
edge is  a  commodity  variously  acquired  and  in  medicine  at  least, 
as  in  the  arts  allied  to  medicine,  there  is  something  still  to  be  said 
of  the  value  of  service  in  close  and  intimate  association  with  the 
master. 

We  might  properly  emphasize  many  interesting  incidents  in  the 
origin  and  progress  of  our  several  departments  in  their  march  through 
the  century.  We  might  speak  of  the  growth  of  institutional  teach- 
ing in  law  in  which  the  University  of  Maryland  was  almost  pioneer. 
We  might  outline  the  part  played  by  our  medical  school  in  the  early 
teaching  of  specialties  or  speak  of  the  beginnings  here  in  Baltimore, 
the  home  of  the  first  dental  college  in  the  world,  of  the  teaching  of 
dentistry.  If  it  were  not  that  Dr.  Cordell  has  left  so  little  to  be 
said  we  might  with  becoming  veneration  speak  of  a  number  of  re- 
markable men  connected  with  the  University,  not  only  in  its  earlier 
day  but  throughout  its  course.  Of  one  we-  should  speak  and  on 
the  walls  of  his  splendid  edifice  in  which  for  a  longer  time  than  in 
any  building  in  America  medicine  has  been  taught,  should  inscribe 
a  tablet  to  the  memory  of  the  talented  architect  R.  Gary  Long. 
In  all  the  midreaches  in  the  life  of  the  University  admirable  teachers 
attended,  and  in  the  years  that  followed  the  depressed  period  of 
the  Civil  War  there  came  a  conspicuous  revival  in  civic  and  intel- 
lectural  affairs  notably  quickened  in  Baltimore  by  the  galaxy  of 
stars  that  came  out  of  the  south.  It  is  no  disparagement  to  the 
prominent  native  Marylanders  and  others  that  this  influence  was 
sometimes  predominant  and  often  important.  Of  such  men  con- 
nected with  the  University,  or  with  schools  now  associated,  I  may 
name  among  doctors,  Warren,  Howard,  Chisolm,  Miles  Opie,  and 
of  lawyers  Carter,  Marshall  and  Venable. 

The  story  of  the  University  is  a  chapter  in  the  history  of  American 
education.  In  the  early  period  very  similar  conditions  prevailed 
throughout  the  colonies  and  through  the  Revolutionary  era,  and 
at  the  time  of  the  University's  establishment,  the  English  ideal 
and  idea  colored  all  educational  undertakings.  The  tincture  of 
the  Puritan  in  New  England,  that  Puritanism  of  which  was  said 
that  it  ''laid  without  knowing  it  the  egg  of  democracy,"^  was  prob- 
ably in  effect  not  unlike  the  influence  of  the  Quaker  in  Pennsylvania 
and  in  Maryland  and  Virginia  doctrinal  distinctions  in  the  educa- 

^  Lowell. 


Or   ■.? 


L^  100  jj  RIDGELY  B.   WARFIELD 

tional  proje,Qt)^%^/Uatholic  and  Cavalier  were  modified  alike  in  their 
[^CoiinipvGssidn'ojyuie  youth  of  the  land  by  the  spirit  of  freedom  in  a 
-vft6t-^i«W  country.  "Men  were  better  than  their  theology."'  This 
does  not  mean  that  doctrinal  discussions  were  forgotten.  Early 
Americana  is  made  up  for  the  most  part  of  religious  tracts,  the 
first  book  printed  in  Baltimore  was  a  volume  of  sermons  and  re- 
ligious argument  and  dispute  was  particularly  vehement  indeed 
the  chief  intellectual  recreation  of  the  time,  but  the  influence  of 
it  all  on  the  lives  of  men  was  softened  by  the  compelling  atmosphere 
of  the  wilderness. 

However  denominational,  early  educational  endeavor  was  always 
highly  moral  not  only  in  designation  but  in  fact,  the  spirit  and  ideals 
were  unmistakably  fine  and  of  the  largest  importance  in  the  build- 
ing of  a  great  nation. 

It  was  all  very  crude  but  not  commonplace,  immature  and  in- 
complete, real  scholarship  was  uncommon,  but  it  was  vital  and  young 
and  wholesomely  vigorous.  And  there  were  giants  in  those  days. 
I  have  often  wondered  if  Thomas  Jefferson  riding  horseback  from 
Charlottesville  to  Washington  or  bumping  by  coach  to  Philadelphia, 
building  the  while  his  fine  philosophies  and  with  orderly  thinking 
composing  his  wonderful  letters,  could  have  accomplished  so  much 
from  the  upholstered  comforts  of  a  Pullman. 

Compared  with  the  European  output  our  intellectural  achieve- 
ments were  perhaps  negligible  but  our  people  were  few  and  scattered 
and  with  small  opportunity.  The  well  known  criticism  of  Sj^dney 
Smith  in  1820  if  true  for  the  time  was  unfair.  Who  said  he  "in 
the  four  quarters  of  this  globe,  reads  an  American  book?  or  goes 
to  an  American  play?  or  looks  at  an  American .  picture  or  statue? 
What  does  the  world  yet  owe  to  American  physicians  or  surgeons? 
What  new  substances  have  their  chemists  discovered?  or  what  old 
ones  have  they  analyzed?  What  constellations  have  been  discov- 
ered by  the  telescope  of  Americans?  What  have  they  done  in 
mathematics?  Who  di'inks  out  of  American  glasses?  or  eats  from 
American  plates?  or  wears  American  coats  or  gowns?  or  sleeps  in 
American  blankets?"  How  times  have  changed,  we  have  survived 
such  reproach  and  with  whatever  failings  can  no  longer  be  said  to 
be  unproductive. 

It  cannot  be  claimed  for  education  in  America  that  it  was  for 
the  individual  the  best  obtainable.     European  institutions  far  ex- 

•  Emerson. 


ADDRESS  101 

celled.  Our  pardonable  pride  is  that  it  has  never  recognized  class 
distinction  but  has  from  the  beginning  been  formulated  and  advanced 
for  the  benefit  of  all  the  people  and  well  did  Lowell  say,  "It  was  in 
making  education  not  only  common  to  all  but  in  some  sense  com- 
pulsory on  all,  that  the  destiny  of  the  free  republics  of  America  was 
practically  settled."  The  typical  American  is  not  enamored  with 
class,  he  has  small  regard  for  aristocracy.  He  worships  the  hero 
and  sometimes  the  pseudo-hero,  he  loves  capacity  and  sometimes 
by  chance  its  mimicry  and  with  many  another  may  for  a  season 
follow  a  fraud  or  flatulence.  But  he  is  not  easily  deceived,  for  him 
a  ruling  class  is  non  existent,  the  suggestion  of  divine  right  in  heredi- 
tary government  absurd  and  he  has  on  the  whole  a  not  extraordi- 
nary respect  for  prophets,  priests  and  Kings.  Especially  Kings: 
yet  the  name  should  not  offend.  "King,  Koenig,  one  who  can"  said 
Carlyle,  and  indeed  back  of  every  line  of  Kings  was  an  originator 
of  strength  a  masterful,  successful  soldier  in  some  of  the  world's  wars. 
But  this  American  is  very  human.  The  story  of  strong  men  and 
gentlemen  through  all  the  ages  is  a  fascinating  one.  Our  young 
people  and  their  elders  too  thrilled  by  the  recital  of  Walter  Scott 
have  lived  on  equal  terms  with  the  participants  in  the  romantic 
world  he  pictured.  Our  young  men  and  maidens  have  peopled 
Kenilworth,  have  jousted  with  Ivanhoe  and  many  an  American 
Lochinvar  has  gone  into  the  west.  We  have  lived  in  palaces  built 
by  the  enchantment  of  Merlin.  We  have  approached  with  loving 
reverence  Malory's  blameless  King  Arthur  and  especially  have 
wandered  with  Launcelot  that  gentlest,  kindest,  sinfulest  of  Knights. 
Gallantly  too  and  smartly  'clad  all  in  green'  with  Queen  Guenever 
and  certain  Knights  of  the  Table  Round  we  have  mounted  our  horses 
and  ridden  on  "maying  through  the  woods  and  meadows  in  great 
joy  and  delights."^  Are  our  ears  dulled  to  the  merry  laughter, 
is  there  no  longer  enchantment  in  the  vision  of  that  time  when  all 
were  blithe  and  debonair?  Then  undoubtedly  we  are  growing  old.^ 
But  there  is  no  lack  of  vision.  The  American  youth  appreciates 
that  he  is  heir  to  the  ages  and  entitled  to  all  the  benefits  of  the  pres- 
ent. He  knows  that  only  as  yesterday  the  printed  book  was  a 
symbol  of  mysticism  and  that  the  man  who  could  read  it  was  an 
object  of  awe,  if  not  of  reverence,  to  the  people.  He  knows  that  in 
the  early  day  learning,  largely  ecclesiastical  and  the  privilege  of  the 

*  Malory, 

'  See  Samuel  McChord  Crothers  'Evolution  of  the  Gentleman.' 


102  RIDGELY  B.   WARFIELD 

few,  is  now  by  the  growth  of  the  spirit  of  Democracy  of  necessity 
to  be  distributed  to  all  mankind.  He  knows  that  knowledge  is 
power  and  that  there  is  no  virtue  in  ignorance,  which  is  even  now 
by  far  the  greatest  evil  in  the  world.  It  cannot  be  disputed  that 
much  of  human  endeavor  is  fatuous.  It  may  be  argued  that  in- 
tellectual achievement  in  the  past  was  greater  than  in  the  present 
and  that  most  of  our  vaunted  progress  is  that  of  the  man  lost  in  the 
forest,  in  a  circle  leading  nowhere.  With  civilized  Europe,  the 
cradle  of  all  our  enlargements,  torn  and  distracted  in  the  cata- 
clysm of  hideous  protracted  war  we  may  easily  be  overwhelmed 
in  despair  for  the  future. 

Only  in  knowledge  of  the  truth  is  liberty.  The  only  remedy  is 
enlightenment  and  the  paramount  duty  of  the  State  lies  in  the 
adequate  education  of  her  sons.  The  infallible  evidence  of  human 
progress  is  that,  whatever  the  present  embarrassments  in  the  art  of 
teaching,  not  one  of  us  would  willingly  return  to  the  narrower  oppor- 
tunities of  the  past.  In  truth  there  is  just  now  a  lack  of  agreement 
among  the  experts  of  certain  featm'es  in  the  modern  educational 
scheme,  the  very  fruit  of  our  development.  This  is  easily  under- 
stood since  radical  ideas  and  methods  everywhere  prevalent  could 
certainly  not  escape  so  shining  a  target.  According  to  Mr.  Stearns^ 
"The  modern  ideal  at  its  basis  is  frankly  materialistic  and  utiHtarian," 
practical  efficiency  is  its  goal  and  against  the  fine  old  cry  of  "Fit 
om-  youth  to  live,  there  arises  a  modern  demand  to  Fit  our  youth 
for  life."  Mr.  Stearns  argues  that  although  eager  to  discard  edu- 
cational methods  that  have  served  for  generations  the  modern  peda- 
gogical authorities  have  not  yet  offered  an  adequate  substitute. 
The  modernist  has  decided  "that  intellectual  power  acquired  through 
the  study  of  any  given  subject  cannot  be  utilized  for  other  work," 
that  many  studies  are  entirely  useless  and  that  among  other  things 
the  old  curriculmn  largely  Hnguistic  is  to  be  supplanted  by  one  that 
is  primarilj^  scientific  and  technical.  President  Eliot  for  half  a 
century  the  notable  apostle  of  observational  studies  and  the  buildei 
in  Harvard  University  of  many  unique  modifications  in  educational 
method  is  arrayed  where  he  should  be  with  the  modernist.  11 
were  better  that  he  were  wrong  in  a  too  advanced  position  than 
that  toward  the  end  of  his  distinguished  career  he  should  be  entangled 
in  the  meshes  of  any  sort  of  intellectual  Toryism.  Also  cited  by 
Mr.  Stearns  our  friend  Mr.  Flexner  is  in  the  arena.     One  of  1)1^ 

*  Alfred  E.  Stearns,  Head  Master,  Phillips  Academy,  Andover. 


ADDRESS  103 

papers  I  have  read  under  the  title  "Parents  and  Schools"  recently- 
published  in  the  Atlantic.  We  have  had  our  battles  with  Mr.  Flex- 
ner,  he  is  a  very  talented  man.  An  extreme  exponent  of  vocational 
method,  he  does  not  believe  in  'mental  discipline'  which  he  dis- 
misses as  an  impressive  pln-ase.  Latin  and  mathematics  he  espe- 
cially singles  out  for  attack.  As  viewed  by  him  the  interest  of  the 
individual  child  should  be  the  dominating  factor  in  early  training 
and  the  teaching  of  the  future  is  to  depend  entirely  "on  what  is 
needed,  when  it  is  needed,  and  the  form  in  which  it  is  needed." 
Of  all  this  subject  of  immeasurable  importance  I  have  no  right  to 
opinion.  I  believe  in  observational  study,  for  the  students  that  I 
encounter,  Medical  Seniors,  can  be  taught  except  supplementaril}^ 
in  no  other  way,  but  for  the  sort  of  training  requu-ed  to  fit  them  to 
study  medicine  at  all,  that  is  another  story.  It  is  useless  to  cite 
examples  of  great  men  who  have  achieved  without  formal  training 
for  there  is  a  degree  of  excellence  that  insures  opportunity  and  is 
superior  to  all  method.  For  my  part  I  have  never  been  educated 
in  a  real  sense  not  even  in  medicine,  for  with  every  veneration  for 
our  Alma  Mater  and  its  skilled  teachers  a  third  of  a  century  gone 
medical  instruction  was  then  very  casual  and  impersonal.  In  aH 
my  adult  Ufe  I  have  felt  the  lack  of  adequate  formal  training.  I 
had  the  advantage  extolled  by  Dr.  Eliot  of  being  a  boy  in  the  coun- 
try. I  was  blessed  with  a  gifted  mother  who  devoted  her  life  to 
the  intellectual  as  well  as  moral  betterment  of  her  children.  To 
her  I  owe  a  studious  habit,  a  love  of  books  and  some  appreciation 
of  the  gems  in  literature.  I  had  other  teachers,  good,  bad  and  in- 
different, but  I  never  had  the  benefit  of  systematic  sustained  dis- 
cipline. Too  young  I  engaged  in  the  study  of  medicine,  my  im- 
maturity was  not  taken  into  account  in  the  Dean's  office.  As  a 
postgraduate  I  undertook  laboratory  work  that  would  now  be 
scorned  by  a  sophomore.  How  I  envied  in  that  day  my  comrades 
of  riper  scholarship.  I  have  even  begrudged  Dr.  Johnson  his  ex- 
perience who  said  of  his  rich  store  of  Latin  that  it  had  been  beaten 
into  him  with  a  rod.  Perhaps  the  modernist  would  endorse  my 
training,  it  was  selective  and  observational,  but  I  still  regret  its 
deficiencies.  I  do  not  believe  that  the  child  nor  the  adolescent, 
except  in  a  limited  way,  should  be  permitted  to  choose  either  the 
subject  or  the  method  of  his  training.  I  believe  in  mental  dis- 
cipline, in  respect  for  authority,  in  the  sense  of  obhgation,  and  in  the 
compulsion  of  doing  the  set  task.  I  believe  in  the  formation  of 
the  habit  of  learning  anything  and  for  end  result  I  had  rather  stand 


104  RIDGELY   B.    WARPIELD 

sponsor  with  old  curriculum  for  the  farmer's  boy  of  reasonable  in- 
telligence who  cheerfully  and  steadfastly  does  a  man's  work  at 
heavy  toil  as  a  matter  of  course  from  a  sense  of  duty,  than  for  the 
favored  youngster  however  intelligent  who  cloyed  with  opportunity 
has  to  be  spiured  to  activity  by  fascinating  paraphernalia  and  ap- 
paratus of  modern  method.  I  believe  the  discussion  is  wholesome 
and  tunely  and  that  in  the  end  formalist  and  modernist  will  face 
their  problems  from  a  uniform  improved  position.  There  is  now 
agreement  that  in  primary  and  secondary  education  time  is  wasted 
and  that  "several  years  may  be  saved  with  distinct  advantage  in 
the  early  period  of  the  child's  education," 

Wherever  we  have  arrived  we  may  be  sm-e  of  the  advance.  There 
is  no  lack  of  material  progress.  Our  young  repubhc  born  of  our 
fathers  has  across  the  era  of  the  past  century  come  down  to  our 
own  amazingly  rich  and  prosperous.  By  native  growth  and  with 
many  accessions  our  land  is  peopled,  great  cities  have  arisen,  great 
distances  annihilated,  great  industries  multiphed  without  end.  It 
is  all  very  wonderful  but  it  is  not  surprising  that  some  of  us  are  a 
little  weary  with  the  incessant  reverberation  of  a  restless  machine 
di'iven  world. 

Intensely  practical  we  crown  as  heroes  men  of  science,  inventors, 
craftsmen,  captains  of  industry,  who  by  harnessing  and  directing 
the  natural  and  human  forces  of  the  eai"th  forward  its  marvelous 
activities.  But  do  we  not  too  Httle  regard  our  finer  possessions 
largely  ideal,  the  influences  that  thi'ough  the  centuries  have  moulded 
and  elevated  humanity,  the  riches  that  have  been  given  us  by  the 
world's  great  teachers,  philosophers  and  thinkers?  Yet  these  are 
the  things  that  hold,  nothing  material  lasts,  the  dreadnaught  of 
today  becomes  junk  tomorrow,  the  idea  is  the  only  permanence. 
On  a  path  blazed  by  generations  of  strong  men  we  have  come  to  om* 
opportunity  and  for  us  at  least  in  spite  of  a  mighty  dissonance  in 
the  world  the  earth  is  attune.  You  young  men  with  many  an  ad- 
vantage denied  your  elders  are  attached  to  the  University  at  the 
best  period  of  her  existence.  The  day  is  a  new  day  and  it  is  yours 
provided  only  that  you  are  teachable.  Your  concern  is  not  with 
the  past. nor  with  the  future  but  at  your  feet  and  in  the  living  pres- 
ent your  duty  Hes.  The  only  necessary  equipment  is  strength, 
insured  in  you  by  youth  and  health  and  fair  intelligence,  and  if  you 
use  the  God  given  strength  in  you  in  the  acquuement  of  the  habit 
of  honest  faithful  work  all  things  else  will  be  added  unto  you.  And 
your  work  is  at  hand,  here  not  elsewhere.     Do  you  recall  the  story 


ADDRESS  106 

of  the  ship  after  long  voyage,  her  water  gone,  becalmed  far  away 
from  her  South  American  destination?  Her  sailors  famished  at 
last  sight  a  vessel  against  the  horizon,  and  with  frantic  solicitude 
send  up  the  signal  "We  want  water."  The  answer  is  returned 
"Put  down  your  buckets  where  you  are."  Incensed  with  the  mock- 
ery again  the  signal  "We  are  dying  for  water"  and  again  the  answer 
"Put  down  your  buckets  where  you  are."  Then  desperate  some 
sailor  thi'ows  into  the  sea  his  bucket  which  when  brought  to  the 
deck  is  filled  with  fresh  clear  water.  Without  knowing  it  they  are 
in  the  flow  of  the  vast  Amazon,  which  for  more  than  an  hundred 
miles  sweetens  the  ocean. 

Said  Carlyle,  "Om-  main  business  is  not  to  see  what  hes  dimly  at 
a  distance,  but  to  do  what  lies  clearly  at  hand."  Dr.  Osier  to  whom 
this  community  owes  so  much  in  a  delightful  lay  sermon  before  a 
body  of  students,  has  testified  that  tiiis  sentence  read  by  him,  in 
1871,  when  harassed  by  coming  examinations,  and  worried  for  the 
futm'e,  "hit  and  stuck  and  helped"  and  was  the  starting  point  of  a 
habit  of  daily  work,  which  has  enabled  him  to  utihze  his  talent  to 
the  full. 

More  than  ever  today  there  are  many  answers  to  old  questions, 
but  to  older  questions  still  there  are  no  new  repHes,  nor  shall  be. 
Youth  attends  poHtely  to  the  counsel  of  its  elders  not  unmindful 
of  its  limited  value.  The  elder  may  point  the  way,  may  encourage 
and  even  accompany  youth  to  the  test  of  his  endeavor  but  surely 
by  his  own  strength  shall  he  stand  or  fall. 

It  is  all  so  simple,  only  work  at  whatever  is  at  hand.  But  without 
haste,  it  is  written  "Youth  enjoyeth  not,  for  haste"  and  "without 
thought  for  the  morrow"  your  performance  today  your  only  anx- 
iety. Seek  not  to  measure  your  own  advancement,  only  Carry 
on.  That  we  call  success  is  often  failure  and  out  of  repeated  fail- 
ure success  often  emerges  in  the  end.  Be  not  discouraged.  Open 
the  windows  of  your  imagination,  and  hsten  for  the  song  of  Pippa 
as  she  passes: 

"The  year's  at  the  spring 

And  day's  at  the  morn; 
Morning's  at  seven; 

The  hill-side's  dew-pearled; 
The  lark's  on  the  wing; 

The  snail's  on  the  thorn; 
God's  in  his  heaven — 

All's  right  with  the  world  !"^ 

''  Browning. 


106  ALEXIUS   MCGLANNAN 

THE    PROPHYLAXIS    AND    TREATMENT    OF    TETANUS^ 
By  Alexius  McGlannan,  M.D. 

The  Fourth  of  July  statistics  published  in  the  Journal  of  the  Ameri- 
can Medical  Association  have  each  year  furnished  new  proof  of  the 
value  of  the  prophylactic  injection  of  antitoxin  in  the  treatment  of  a 
class  of  wounds  from  which  tetanus  is  likely  to  develop.  Most 
surgeons  are  convinced  of  the  usefulness  of  this  injection  and  em- 
ploy the  antitoxin  when  dealing  with  a  suspicious  wound.  If  fur- 
ther proof  is  necessary  the  reports  coming  from  the  present  Euro- 
pean war  furnish  an  impressive  confirmation.  The  large  contused 
and  lacerated  wounds  produced  by  shrapnel,  the  infectiousness  of 
the  highly  cultivated  soil  and  the  peculiar  conditions  of  trench  war- 
fare, all  combine  to  make  a  wound  in  which  the  development  of 
tetanus  is  an  almost  certain  complication.  During  the  early  months 
of  the  war  the  reports  showed  an  enormous  number  of  cases  of  tet- 
anus and  a  large  mortality  from  this  cause.  Ritter's  statistics 
show  that  more  than  half  the  deaths  were  from  tetanus.  As  soon, 
however,  as  the  preventive  injection  at  or  near  the  front  became 
possible,  the  number  of  cases  immediately  became  fewer  and  with 
the  extension  of  the  use  of  this  prophylactic  injection  there  has  been 
a  steady  reduction,  until  tetanus  has  become  a  rare  complication. 

A  short  review  of  the  life  history  and  action  of  the  tetanus  bacil- 
lus will  show  the  reasons  for  the  methods  of  prophylaxis  and  treat- 
ment to  be  described. 

The  organism  is  a  spore  bearing  anaerobic  bacillus.  The  spores 
are  extremely  resistant  and  unusually  virile.  Undoubted  proof 
exists  of  the  persistent  virulence  of  spores  dormant  for  several 
years,  and  especially  when  they  have  been  protected  from  sunlight 
and  similar  influences. 

Recent  investigation  by  Noble  {Jour.  Infec.  Dis.,  1915,  xvi,  132) 
shows  that  the  bacillus  occurs  in  the  intestine  of  many  herbivorous 
animals,  especially  in  horses.  Further  Noble  states  that  the  organ- 
ism may  multiply  in  susceptible  animals.  In  the  case  of  one  horse, 
the  animal  proved  a  tetanus  carrier,  the  organisms  remaining  in  the 
feces  for  a  period  of  four  months,  although  they  disappeared  from  a 
control  animal  in  fourteen  days.  This  work  explains  the  source  of 
contamination  of  soils,  street  dust,  fresh  vegetables,  and  of  the 

*  Read  at  the  meeting  of  the  Association  of  Military  Surgeons  of  the  United 
States,  Washington,  D.  C,  September  16,  1915. 


PEOPHYLAXIS   AND    TREATMENT   OF   TETANUS  107 

clothing  and  skin  of  those  who  work  about  stables  and  animal 
shelters. 

The  dust  of  old  walls  and  of  cellars  usually  harbors  tetanus 
spores,  probably  a  secondary  development  from  street  and  soil 
dust.  The  wad  of  a  blank  cartridge  is  usually  infected,  also  some 
forms  of  felt,  and  various  fibers  occasionally  used  in  the  manufacture 
of  dressing  or  fixation  materials  for  wounds. 

The  spores  resist  disinfectants  and  antiseptics  and  it  is  necessary 
to  use  high  temperature  persistently  in  order  to  sterilize  contami- 
nated material.  Of  chemical  disinfectants,  chlorinated  lime,  phe- 
nol and  iodoform  have  all  been  found  useful. 

When  a  susceptible  animal  is  inoculated  with  tetanus,  the  or- 
ganism's produce  a  toxin  at  the  site  of  the  inoculation.  From  this 
point  the  toxin  travels  by  way  of  the  nerve  fibres  to  reach  the  spinal 
cord  and  through  the  cerebro-spinal  fluid  to  the  brain.  Some  ab- 
sorption into  the  circulation  also  occurs  at  the  focus  of  entry,  and 
there  is  an  accumulation  of  toxin  in  the  blood.  The  effect  of  the 
toxin  is  borne  by  the  cells  of  the  central  nervous  system  and  the 
symptoms  of  tetanus  are  the  result  of  this  action.  Death  usually 
results  from  a  combination  of  two  causes, — overwhelming  toxaemia 
and  exhaustion  from  the  exertion  of  the  convulsions  added  to  the 
loss  of  nourishment  brought  about  by  the  dysphagia. 

The  prophylaxis  of  tetanus  therefore,  begins  with  the  recognition 
of  suspicious  wounds.  Such  wounds  should  have  appropriate  local 
treatm.ent  and  the  patient  should  always  be  given  a  preventive 
dose  of  tetanus  antitoxin,^  as  soon  as  possible  after  the  injury. 
Forty-eight  hours  seems  the  limit  of  time  for  certain  protection. 
This  injection  should  be  given  into  or  around  the  principle  nerve 
supplying  the  region  of  the  wound,  between  the  wound  and  spinal 
column.  Exposure  of  the  nerve  in  an  open  wound  for  the  purpose 
of  making  the  injection  or  for  drainage  seems  unnecessarily  radical. 

Suspicious  wounds  are  those  inflicted  in  any  of  the  ordinary 
habitats  of  the  tetanus  bacillus,  especially  deep  punctures  and 
wounds  having  much  contusion  and  laceration.  Wounds  which  in- 
volve the  more  compact  tissues,  as  tendon  and  aponeurosis  are 
particularly  susceptible  to  tetanus  infection,  especially  when  such 
wounds  are  gangrenous. 

2  The  usual  prophylactic  dose  is  1500  units.  Reports  from  the  war  indicate 
that  smaller  quantities  as  low  even  as  20  units  may  be  sufficient. 


108  ALEXIUS  MCGLANNAN 

Saprophytic  and  pyogenic  bacteria  contaminating  a  wound  may 
assist  in  the  development  of  tetanus,  by  using  up  the  oxygen. 
(Muhsam:  J.  A.  M.  A.,  December  26,  1914,  Ixiii,  2310.) 

The  onset  and  severity  of  tetanus  bears  no  relation  to  the  size 
of  the  wound.     A  fatal  infection  may  follow  a  superficial  abrasion. 

Of  interest  to  the  military  surgeon  is  Walther's  observation  that 
tetanus  is  rare  after  rifle  wounds  and  common  in  shrapnel  injuries. 

Also  Czerny's  report  of  four  cases  of  tetanus  that  developed 
during  the  journey  back  from  the  firing  line,  in  which  the  infection 
was  attributed  to  contamination  from  the  cars.  These  cars  had  been 
used  for  transporting  horses  up  and  were  not  cleaned  before  loading 
the  wounded  for  the  return  journej^  This  report  shows  a  route  for 
infection  that  might  easily  be  overlooked  in  the  stress  of  a  campaign. 

Infection  by  contact  is  possible,  therefore  tetanus  patients  should 
be  separated  from  other  wounded  as  far  as  can  be,  while  the  wounded 
that  are  necessarily  companions  of  the  tetanus  cases  should  be  given  a 
protective  injection.  In  field  surgery  contact  of  the  wounded  with 
straW;  etc.,  should  be  prevented  by  spreading  a  tent  or  blanket 
under  the  patient. 

The  local  treatment  of  a  suspicious  wound  varies  with  its  charac- 
ter. When  possible,  complete  excision  of  the  focus  is  advisable. 
Deep  punctures  should  be  laid  open  and  all  the  wound  should  be 
disinfected  and  given  free  drainage.  It  is  important  that  the  wound 
surface  be  kept  moist  and  free  from  drying  scabs.  For  this  pur- 
pose some  oily  dressing,  such  as  Balsam  of  Peru  is  valuable.  The 
exposure  of  the  wound  to  a  current  of  oxygen  or  air,  has  been  recom- 
mended, but  is  seldom  practicable. 

Of  the  local  antiseptics,  phenol  is  the  time  honored  agent.  It  has 
a  vigorous  bactericidal  action,  but  its  caustic  properties  make  it 
difficult  to  handle  and  control.  Bleaching  powder,  in  som.e  modi- 
fication, is  now  being  used  in  Europe.  A  10  per  cent  mixture  of  this 
agent  and  some  inert  mineral  powder  is  advised  as  a  dusting  pow- 
der. The  Carrell-Dakin  solution'  seems  a  better  way  to  apply 
this  agent,  because  impermeable  crusts  are  less  likely  to  be  formed. 

'  This  antiseptic  is  made  by  dissolving  200  grams  of  chlorinated  lime  in  5 
litres  of  water  and  adding  to  this  a  solution  of  100  grams  of  anhydrous 
sodium  carbonate  and  80  of  sodium  bicarbonate  in  5  litres  of  water,  thor- 
oughly shaking  the  mixture.  The  precipitated  calcium  carbonate  is  allowed 
to  collect  in  the  bottom  of  the  container  and  the  supernatant  liquid  is  filtered 
through  cotton.  To  this  filtrate  boric  acid  is  added  until  the  solution  becomes 
faintly  acid.     Usually  about  25  to  40  grams  of  boric  acid  will  be  required. 


1»R0PHYLAXIS  AND   TREATMENT   OF  TETANUS  109 

Kitasato's  experiments  with  iodoform  proved  the  antagonism  be- 
tween this  drug  and  the  tetanus  organism.  The  efficiency  of  the 
drug  seems  to  he  in  the  gradual  hberation  of  iodine  from  the  im- 
pregnated tissues.     Other  iodine  derivatives  have  the  same  action. 

The  value  of  iodine  as  a  disinfectant  of  wounds  is  disputed  by 
many  observers,  although  the  most  universal  adoption  of  this  agent 
in  civil  surgery  seems  to  prove  its  usefulness. 

Tinker  shows  that  iodine  applied  to  the  tissues  will  not  destroy 
contained  spores  and  therefore  it  should  be  useless  in  the  prophy- 
laxis of  tetanus.  On  the  other  hand  we  have  the  work  of  Kitasato 
showing  the  value  of  iodoform,  and  the  usual  explanation  of  its 
action.  Without  attempting  to  reconcile  this  difference  of  opinion, 
we  may  consider  some  of  the  advantages  of  iodine  in  the  treatment 
of  an  infected  wound. 

1.  It  is  practically  non-toxic  and  therefore  may  be  used  freely. 

2.  It  is  not  a  caustic  and  does  not  sear  the  surface  of  the  wound. 

3.  It  will  prevent  the  growth  of  ordinary  pyogenic  organisms. 

4.  It  produces  a  marked  and  long  sustained  local  hyperaemia. 
This  last  is  probably  its  greatest  value. 

The  treatment  of  the  wound  however  is  not  so  important  as  is  the 
prophylactic  injection  of  antitoxin,  and  if  one  or  the  other  must  be 
postponed,  the  delay  in  the  wound  treatment  is  the  lesser  evil.  This 
point  is  of  great  importance  in  military  surgery.  Wound  treatment 
beyond  the. simplest  first  aid  is  rarely  possible  for  many  hours  or 
even  days  after  the  occurrence  of  the  injury.  The  injection  is  a 
simple  procedure,  and  with  a  sufficient  supply  of  antitoxin  avail- 
able, could  be  carried  out  at  the  advanced  dressing  station,  and  at 
the  station  for  the  slightly  wounded. 

Aschoff  and  Robertson  {J.  A.  M.  A.,  August  21,  1915,  Ixv,  748) 
recommend  soaking  absorbent  cotton  in  antitoxin  and  drying  it. 
This  impregnated  cotton  may  be  applied  to  large  wounds  and  when 
it  becomes  moistened  by  the  secretion  the  antitoxin  is  liberated  into 

The  neutralization  of  the  alkaline  solution  by  boric  acid  gives  this  new 
antiseptic  solution  its  advantage  over  Javal  water  and  Labarraques'  solution, 
both  of  which  contain  available  chlorine  in  the  form  of  alkaline  hypochlorite. 
The  solution  should  never  be  heated.  Made  with  the  correct  chemical 
salts  it  should  contain  about  5  gram  per  cent  of  sodium  hypochlorite.  The 
hypochlorite  concentration  should  be  estimated  by  titrating  the  solution 
with  decinormal  sodium  thiosulphate  after  the  addition  of  a  measured  quan- 
tity of  potassium  iodide  and  acetic  acid. 


110  ALEXIUS  MCGLAKNAN 

the  tissues.  The  possibihty  of  utilizing  this  device  is  invited  to 
the  attention  of  the  recently  organized  First  Aid  Conference. 

On  account  of  the  frequent  persistence  of  the  tetanus  bacillus 
in  the  tissues,  the  protective  action  of  the  serum  is  limited  to  a 
period  of  ten  or  twelve  days.  If  the  wound  has  not  entirely  healed 
in  this  length  of  time,  the  injection  should  be  repeated.  (Irons: 
J.  A.  M.  A.,  May  8,  1915,  Ixiv,  1554.) 

For  the  same  reason  it  is  necessary  to  administer  a  prophylactic 
dose  before  operating  on  sinuses  or  the  wounds  of  those  patients 
who  have  been  exposed  to  the  infection.  Abdominal  operations  in 
which  much  damage  is  done  the  intestinal  wall,  as  in  separating 
dense  adhesions  or  operations  for  the  closure  of  long  standing  fecal 
fistulae  occasionally  are  followed  by  tetanus.  To  avoid  this  com- 
plication a  prophylactic  injection  of  antitoxin  should  be  given 
whenever  such  an  operation  is  performed. 

The  treatment  of  tetanus  aims  to  provide  for  six  conditions: 

1.  The  neutralization  of  the  toxin  in  the  cerebro-spinal  fluid  and 
in  the  blood. 

2.  Luniting  or  preventing  the  development  of  toxin  at  the  focus 
of  infection. 

3.  Interruption  of  the  flow  of  toxin  from  the  wound  to  the  central 
nervous  system. 

4.  Preservation  of  the  nutrition  of  the  patient. 

5.  Prevention  of  convulsions  by  protecting  the  patient  from 
external  stimuli. 

6.  Control  of  convulsions  by  abolition  or  obtunding  of  reflexes. 
The  first  condition  is  met  by  the  injection  of  antitoxin  into  the 

spinal  canal  and  intravenously.  Ashurst  and  John  (A.  J.  M.  S., 
June,  1913)  outline  a  method  of  treatment,  which  has  been  modi- 
fied by  the  work  of  Park  and  Nicoll  (Jour.  A.  M.  A.,  1915,  Ixiv, 
1982).  Ten  to  fifteen  thousand  units  of  antitoxin  are  given  intra- 
venously and  5000  units  into  the  spinal  cord.  The  spinal  injection 
is  given  through  the  needle  which  has  made  a  prehminary  lumbar 
puncture.  Should  the  spinal  fluid  be  under  increased  pressure  (a 
rare  occurrence)  a  quantity  equal  to  or  greater  than  the  volume  of  the 
antitoxin  should  be  removed  before  making  the  injection.  When 
the  symptoms  are  marked  ether  anaesthesia  may  be  required  for 
making  the  puncture. 

There  is  a  difference  of  opinion  regarding  the  management  of  the 
wound  after  the  disease  has  developed.     On  the  one  hand  excision 


PROPHYLAXIS  AND   TREATMENT   OF   TETANUS  111 

is  advised  for  the  purpose  of  removing  the  focus,  on  the  other  it  is 
condemned  on  the  ground  that  such  an  operation  only  opens  up 
new  avenues  for  dissemination  of  toxin  and  bacteria. 

The  best  method  seems  to  be  non-interference  unless  the  wound 
clearly  requires  opening  for  drainage  and  disinfection.  Occasion- 
ally it  may  be  well  to  make  injections  of  antitoxin  into  the  tissues 
around  the  wound.  Hydrogen  peroxide,  oxygen  spray,  etc.,  have 
no  specific  value  in  treating  the  wound. 

For  the  third  condition,  intraneural  injections  of  antitoxin  are 
efficacious.  Such  proceedures  as  section  of  all  the  nerves  from  a 
limb  and  bringing  the  peripheral  ends  out  of  the  wound  for  drainage 
are  unnecessary  and  unduly  radical.  The  same  seems  true  of  the 
introduction  of  drainage  tubes  into  the  nerve. 

It  is  better  judgment  to  refrain  from  all  avoidable  traumatism 
and  to  rely  on  the  antitoxin  introduced  into  the  cerebro-spinal  fluid 
and  the  blood  for  combatting  the  toxin. 

The  nutrition  of  the  patient  is  of  extreme  importance.  As  long 
as  he  can  swallow  without  difficulty  this  is  a  simple  matter.  When 
dysphagia  is  present,  when  the  spasm  of  the  jaw  muscles  keeps  the 
mouth  tightly  closed,  the  problem  becomes  difficult.  Nutrient 
enemas  help  for  a  short  time,  but  every  effort  must  be  directed 
toward  the  relaxation  of  the  spasm. 

Morphia  hypodermically  is  most  useful  in  early  cases  when  spasm 
of  respiration  and  deglutition  are  often  the  only  symptoms.  Chloral 
hydrate  in  large  doses  sufficiently  great  to  produce  a  distinct  stupor 
is  valuable,  but  the  large  doses  necessary  (20  to  25  grams  daily) 
are  not  without  danger. 

Magnesium  sulphate  intraspinously  is  valuable  (Kelly-Musser : 
Practical  Treatment,  vol.  2)  but  not  free  from  danger  on  account  of 
paralysis  of  respiration.  Subcutaneous  injections  of  this  dinig  are 
easier  to  give  but  are  also  somewhat  dangerous.  A  20  or  30  per 
cent  solution  is  used,  and  beginning  with  5  cc.  the  dose  is  gradually 
increased  until  diminished  reflex  activity  is  produced.  A  5  per 
solution  of  calcium  chloride  or  some  ^o  grain  Eserin  tablets  should 
be  available  as  an  antidote. 

About  an  hour  after  the  injection  the  spasms  usually  relax  and 
the  effect  of  the  drug  lasts  about  six  to  eight  hours.  The  injections 
are  repeated  as  soon  as  symptoms  return.  Tightness  of  the  chest 
and  difficulty  in  swallowing  are  usually  the  earliest  signs  of  return- 
ing spasm. 


112  ALEXIUS   MCGLANNAN 

Magnesium  glycerophosphate  has  been  advised  in  place  of  the 
sulphate,  in  the  hope  of  overcoming  some  of  the  bad  effects  of  the 
latter  salt. 

All  manner  of  desperate  means  have  been  advised  for  control  of  the 
spasm  of  respiration.  Section" of  both  phrenic  nerves  was  successfully 
done  by  Jehn  (J.  A.  M.  A.,  November  14,  1914,  Ixiii,  1796)  for  the 
relief  of  this  spasm.  Intratracheal  insufflation  should  be  kept  in 
mind  as  a  means  for  supplying  air  without  respiratory  movement. 

Bacilli's  phenol  injections  have  received  few  reports  in  the  war 
literature.  The  method  has  been  used  by  several  observers  in  the 
last  five  years,  but  the  results  of  this  treatment  are  not  so  good  as 
those  of  the  serum  method. 

The  results  of  intraspinous  and  intravenous  administration  of 
antitoxin  far  surpass  those  of  any  other  form  of  treatment,  and 
whenever  antitoxin  in  sufficient  quantity  is  available  this  should  be 
the  method  of  choice  for  treating  tetanus.  With  a  scarcity  of  anti- 
toxin, the  intraspinous  dose  should  be  given  rather  than  the  intra- 
venous. Bruce  (Brit.  Med.  Jour.,  October  23,  1915,  p.  593)  in  a 
study  of  two  hundred  and  thirty-one  cases  of  tetanus  treated, 
shows  the  best  results  to  follow  repeated  intrathecal  injection  of 
large  doses  of  the  antitoxin. 

Magnesium  sulphate  injections  are  valuable  in  military  surgery 
because  this  agent  is  cheap  and  is  usually  available.  The  prolonged 
abolition  of  reflexes  may  permit  the  conafortable  and  safe  trans- 
portation of  the  wounded  man  to  a  base  hospital.  Combined  with 
a  dose  of  opium  this  seems  the  best  preparation  we  can  give  a  tet- 
anus patient  for  exposure  to  external  stimuli,  when  this  becomes 
necessary.  The  symptoms  of  tetanus  are  aggravated  by  rapid 
travel  and  therefore  the  hospital  train  should  not  go  faster  than 
twenty  miles  an  hour.  (Schmidt:  J.  A.  M.  A.,  April  24,  1915, 
Ixiv,  1458.) 

As  is  true  of  all  infections,  the  efficacy  of  the  treatment  of  tet- 
anus varies  directly  with  the  period  of  the  disease  at  which  it  is 
instituted.  Early  diagnosis  and  prompt  treatment  give  the  best 
hope  for  success.  The  early  symptoms  of  tetanus  are  not  marked, 
but  are  quite  distinct. 

Pain  and  stiffness  in  the  muscles  of  the  region  of  the  wound  may 
be  mistaken  for  a  simple  myalgia,  but  is  easily  differentiated  by 
exaggeration  of  the  local  reflexes,  which  exaggeration  becomes  pro- 
gressive. Twitching  and  stiffness  of  the  muscles  when  these  are 
tapped  is  an  evidence  of  increased  excitability. 


e6le  of  certain  diphtheroid  microorganisms  113 

Pain  about  the  mouth,  fatigue  in  chewing,  shght  difficulty  in 
swallowing  without  any  cause  for  this  condition  evident  in  the  throat, 
is  an  early  and  very  certain  sign  in  a  suspicious  case. 

Cramps  in  the  chest  muscles,  generally  described  as  "a  stitch 
in  the  side"  and  a  sense  of  tightness  in  the  chest  are  other  early 
symptoms.  Profuse  sweating  and  a  rapid  pulse  precede  the  onset 
of  distinct  lockjaw. 

Starting  at  noises,  at  lights  or  in  drafts  is  evidence  of  undue 
reflex  sensitiveness  and  occurring  in  the  wounded  should  give  rise  to 
a  strong  suspicion  of  tetanus. 

In  the  presence  of  any  of  these  signs  the  patient  should  be  placed 
in  the  best  surroundings  possible  for  quiet  and  darkness;  the 
intraspinous  and  intravenous  injections  of  antitoxin  given  as  soon  as 
possible  and  the  general  nutrition  preserved  by  frequent  feeding  of 
small  quantities  of  easily  digested  food;  water  should  be  given  by 
rectum  as  well  as  by  mouth  in  as  large  a  quantity  as  can  be  taken. 
The  spasmodic  or  paralyzed  bladder  may  require  catheterization,  and 
enemas  may  b3  necessary  for  emptying  the  bowels.  Whatever 
manipulations  are  required  must  be  carried  out  with  the  utmost 
gentleness,  and  preceded  by  the  administration  of  opium  if  they 
annoy  the  patient.  Every  effort  must  be  used  fo  limit  the  effect 
of  external  stimuli  on  the  central  nervous  system. 

114  West  Franklin  Street,  Baltimore,  Md. 

THE  ROLE  of  certain  DIPHTHEROID 
MICROORGANISMS 

By  Charles  C.  W.  Judd,  A.B.,  M.D. 

Associate  Professor  of  Medicine,  University  of  Maryland,  School  of  Medicine 
and  College  of  Physicians,  Baltimore,  Md. 

Beginning  with  the  finding  of  Fraenkel  and  Much^  in  1910  up  to 
the  present  time  a  great  deal  of  interest  has  centered  about  the 
occurrence  of  a  certain  organism  or  group  of  organisms  in  various 
pathological  tissues,  with  an  apparent  clearing  up  of  the  aetiology 
of  several  diseases  which  have  been  considered  distinct  clinical 
entities  of  unknown  origin. 

1  Fraenkel,  E.,  and  Much,  H.:  Miinchen.  Med.  Wchnschr.,  1910,  No.  13; 
Ztschr.  f.  Hyg.,  1910,  Ixvii. 


114  CHARLES   C.    W.   JUDD 

The  organism  concerned  has  been  variously  named  corynebac- 
terium  granulomatis  mahgni  or  the  corynebacteriam  Hodgkini  and 
diphtheroids. 

Fraenkel  and  Much  pointed  out  that  pecuhar  granular  bacilli 
may  be  demonstrated  in  the  glands  of  Hodgkin's  cases  which  closely 
resembled  the  granular  type  of  tubercle  bacilli  and  Uke  tubercle 
bacilli  are  resistant  to  antiformin,  but  unlike  them  are  not  acid  fast. 
Moreover  these  organisms  do  not  induce  tuberculosis  in  laboratory' 
animals.  In  their  first  communication  the  writers  report  on  the 
presence  of  these  organisms  in  twelve  of  thirteen  cases,  of  which 
eleven  were  definitely  known  to  be  uncomplicated  by  tuberculosis. 
Subsequently  FraenkeP  states  that  he  obtained  corresponding  find- 
ings in  four  additional  cases.  He  concludes  that  Hodgkin's  disease 
(he  terms  it  Ijonphomatosis  granulomatosa)  is  in  all  probability  an 
infectious  disease,  produced  by  the  organism  in  question  which 
may  be  related  to  but  not  identical  with  the  tubercle  bacillus. 
Regarding  the  morphology  of  the  organism,  he  merely  mentions 
that  it  appears  either  in  the  form  of  isolated  granules  of  variable 
size  or  granules  joined  together  in  bacillary  form.  They  are  de- 
scribed as  being  Gram  positive  and  most  conveniently  demon- 
strated by  antiforminizing  the  involved  glands  and  staining  accord- 
ing to  Much's  modification  of  Gram's  method.  Cultures  of  this 
organism,  however,  were  not  obtained  nor  was  it  possible  to  satis- 
factorily infect  the  common  laboratory  animals.  This  pioneer  work 
of  Fraenkel  and  Much  was  later  abundantly  confirmed  by  numerous 
observers  so  that  at  a  meeting  of  the  Medical  Society  of  Ham- 
burg on  June  2,  1912,  FraenkeP  could  announce  that  the  organism 
in  question  had  up  to  that  date  been  demonstrated  in  more  than 
thirty  cases.  At  this  time,  however,  the  cultivation  of  the  organ- 
ism had  not  met  with  success,  despite  Fraenkel's  statement  that 
every  effort  in  this  direction  had  been  attempted. 

Pure  cultures  were  first  obtained  by  Negri  and  Mieremet*  who 
gave  the  earliest  detailed  description  of  the  organism.  They  em- 
phasized the  pronounced  pleomorphism  or  variability  in  form,  which 
led  them  at  first  to  doubt  the  purity  of  their  cultures,  so  that  they 
resorted  to  Shauten's*  method  of  isolating  a  single  organism,  from 

2  Fraenkel,  E.:  Miinchen.  Med.  Wchnschr.,  1911,  No.  23. 
'  Fraenkel,  E.:  Deutsch.  Med.  Wchnschr.,  1912,  No.  14. 
*  De  Negri,  E.,  and  Mieremet,  C.  W.  G. :  Centralbl.  f.  BakterioL,  Part  1, 
Orig.,  1913,  Ixviii. 

'  Shauten,  S.  L. :  Ztschr.  f.  mss.  Mik.,  1905,  xxii. 


il6L£    OF   CERTAIN   DIPHTHEROID    MICROORGANISMS  115 

which  a  pure  culture  was  then  grown,  in  which  the  same  variability 
in  size  and  form  was  noted  as  in  the  primary  growth.  These  writers 
regard  this  organism  as  identical  with  that  observed  by  Fraenkel 
and  Much  and  classify  it  under  the  genus  corynebacterium,  on  the 
basis  of  its  segmented  structure,  the  tendency  to  attenuated  and 
clubbed  ends  as  well  as  to  true  branching,  besides  the  readiness 
with  which  it  is  stained  with  the  usual  dyes,  without  being  acid 
fast.  Toward  Gram's  stain  the  organisms  from  the  tissues  were 
positive,  while  cultured  organisms  were  at  times  positive  and  at 
others  negative. 

Negri  and  Mieremet  obtained  analogous  results  in  a  second  case. 
In  their  hands  inoculation  experiments  did  not  lead  to  any  definite 
conclusions.  They  nevertheless  felt  justified  in  view  of  their  own 
findings  and  those  of  the  earlier  investigators  in  regarding  the  or- 
ganism as  the  causative  agent  of  Hodgkin's  disease  and  proposed 
for  it  the  name  corynebacterium  granulomatis  maligni. 

A  search  for  corresponding  antibodies  in  one  of  their  patients 
and  a  third  case,  in  which  no  bacteriological  examination  had  been 
possible,  led  to  negative  results  with  reference  to  complement  fixa- 
tion, agglutination  and  cutaneous  reactions. 

Following  Negri  and  Mieremet,  positive  cultural  results  were  re- 
ported by  Bunting  and  Yates,^  and  still  later  Billings  and  Rosenow' 
and  others.  Simon  and  Judd  isolated  the  organism  from  an  unpub- 
lished case,  the  tissue  being  submitted  to  them  for  examination  by 
Dr.  Legge  of  Cumberland,  Maryland.  These  findings  were  fre- 
quently obtained  from  the  lymph  glands  of  Hodgkin's  disease  in 
pure  culture.  More  often  they  were  contaminated  with  staphy- 
lococci. Bunting  and  Yates  proposed  the  binomial  name  of  coryne- 
bacterium Hodgkini  for  the  organism  they  isolated. 

The  results  obtained  by  inoculation  experiments  (Macacus 
rhesus)  have  strengthened  the  idea  that  the  organism  is  actually 
the  causative  agent  of  Hodgkin's  disease.  In  one  of  Bunting  and 
Yates'  animals  a  chronic  lymphadenitis  was  induced  with  atypical 
proliferation  of  the  endothelial  cells,  beginning  proliferation  of  the 
stroma  tissue,  with  marked  eosniophilic  infiltration  and  periglandu- 
lar sclerosis. 

« Bunting,  C.  H.,  and  Yates,  J.  L. :  Arch.  Int.  Med.,  Aug.,  1913;  and  Jour. 
A.  M.  A.,  Nov.  15,  1913. 

'  Billings,  Frank,  and  Rosenow,  E.  C.iJour.  A.  M.  A.,  Dec.  13,  1913. 


L 


116  CHARLES   C.    W.   JUDD 

In  Hodgkin's  disease,  therefore,  the  etiologic  role  of  this  pleo- 
morphic organism  is  fairly  conclusively  established. 

Steele,^  of  Boston,  then  isolated  the  same  organism,  apparently, 
not  only  from  a  case  of  Hodgkin's  disease,  but  also  from  one  of 
lymphatic  leukaemia,  occurring  in  a  boy  of  twelve.  The  duration 
of  the  disease  was  nine  weeks  and  the  blood  picture  was  that  of  the 
acute  type.  Regarding  the  organism  isolated,  he  describes  it  as 
being 

Markedly  pleomorphic.  Most  of  the  organisms  resembled  forms  of  the 
diphtheria  bacillus,  but  some  were  short  and  coccoid.  He  did  not  observe 
any  definitely  branching  forms.  Some  take  the  stain  uniformly,  others  show 
a  granular  character,  while  still  others  take  the  stain  more  deeply  at  the 
ends.  They  stain  by  Gram's  method,  are  not  acid  fast  and  are  resistent  to 
antiformin.  They  grow  at  first  slowly,  being  first  noticeable  after  five  days 
incubation.  Transplants  grow  well  on  most  of  the  ordinary  culture  media, 
but  best  on  media  rich  in  protein.  On  agar  and  blood  serum,  the  lemon 
yellow  fluorescence  observed  by  Negri  and  Mieremet  is  particularly  notice- 
able. On  potatoes  the  growth  appears  as  small  isolated  lemon  yellow  colo- 
nies. The  growth  in  bouillon  or  ascites  bouillon  is  at  first  in  adherent  masses, 
though  later  the  bouillon  is  somewhat  cloudy.  It  grows  in  isolated  yellow 
colonies  in  gelatin  without  liquefaction.  It  does  not  produce  gas  in  glucose 
or  lactose  media. 

So  far  as  we  know  the  first  confirmation  of  the  findings  of  a  simi- 
lar organism  in  leukaemia  was  investigated  by  Simon  and  Jadd." 
In  this  case  the  total  duration  of  the  disease  was  seven  weeks.  The 
blood,  clinical  picture,  and  pathological  sections  of  an  excised  gland 
united  to  form  conclusive  evidence  of  the  case  being  one  of  acute 
lymphatic  leukaemia.  Death  was  due  to  repeated  internal 
hemorrhage. 

Blood  cultures  were  sterile,  and  inoculation  experiments  from 
the  gland  cultures  into  rabbits  and  guinea  pigs  failed  to  produce  the 
lesions  or  blood  picture  of  acute  lymphatic  leukaemia. 

Following  this,  through  the  courtesy  of  Drs.  Kolb  and  Ruhrah  of 
Baltimore,  Simon  and  Judd  had  the  opportunity  of  bacteriologically 
investigating  a  second  (unreported)  fatal  case  of  acute  lymphatic 
leukaemia  in  a  child  two  years  of  age.  Blood  smears  during  life,  and 
the  histological  examination  of  spleen  and  lymph  glands  confirmed 
the  clinical  diagnosis.     Cultures  from  the  spleen  a  few  hours  after 

«  Steele,  A.  E.:  Bost.  Med.  and  Surg.  Jour.,  1914,  clxx,  123. 

9  Simon,  Chas.  E.,  and  Judd,  Chas.  C.  W.:  Jour.  A.  M.  A.,  May  15,  1915. 


r6le  of  certain  diphtheroid  microorganisms  117 

death  were  contaminated  with  staphylococcus  and  later  proteus 
vulgaris.  They  failed  to  obtain  a  pure  culture  of  corynebacterium 
in  this  case.  Morphologically  typical  organisms,  however,  were 
seen  in  smear  from  the  original  cultures.  It  seem.ed  probable  that 
the  contaminating  organisms  were  agonal  or  post  mortem  invadors, 
or,  the  partial  autopsy  being  done  in  the  patient's  home,  that  acci- 
dental contamination  occurred  in  securing  the  cultures. 

Dr.  Simon  and  the  writer,  through  the  courtesy  of  Drs.  Finne^' 
and  Bernheim  of  Baltimore,  grew  an  organism  in  pure  culture  from 
the  excised  spleen  of  an  unreported  case  of  aplastic  anaemia.  This 
organism  corresponded  in  morphology  to  corynebacterium  Hodg- 
kini.  There  were  minor  differences  in  cultural  characteristics,  and 
growths,  both  originally  and  on  transplants,  were  more  luxuriant. 
Indeed  this  strain  seemed  considerably  more  hardy  than  our  earlier 
ones. 

Our  failure  to  cultivate  this  or  any  organism  from  the  spleen  of 
two  pernicious  anaemia  cases  obtained  under  sunilar  circumstances, 
may  or  may  not  be  suggestive  of  a  difference  in  aetiology  of  these 
closely  allied  clinical  entities. 

Yates,  Bunting  and  Kristjanson^^  obtained  an  organism  resem- 
bling those  from  their  Hodgkin's  cases,  from  a  patient  with  Banti's 
disease.  This,  Simon  and  Judd  confirmed  by  cultures  from  the 
spleen  of  an  unreported  case.  Celler  isolated  a  diphtheroid  from 
the  glands  of  a  patient  suffering  with  pseudoleukaemia. 

The  findings  of  Fox^^  and  others  of  a  similar  organism  in  the 
joints  of  some  types  of  arthritis  and  the  surrounding  glands  offer  a 
further  extension  of  the  role  of  this  group  of  organisms  in  patholog3^ 

However  unassociated  the  arthritides  may  appear  from  diseases 
of  the  lymph-adenoid  tissues,  it  is  at  least  suggestive  that  the  sole 
lesion  which  Simon  and  Judd  were  enabled  to  produce  in  inocula- 
tion experiments  on  chickens,  guinea  pigs  and  rabbits,  was  in  one 
of  the  rabbits,  three  months  after  the  intraperitoneal  injection  of 
massive  doses  of  fresh  cultures  obtained  from  their  first  case  of  lym- 
phatic leukaemia.  A  most  marked  emaciation  of  the  animal  accom- 
panied a  destructive  arthritis  of  the  femoral-tibio-fibular  joint. 
From  the  fluid  of  this  joint  a  pure  culture  of  the  original  organism 

"Yates,  J.  L.,  Bunting,  C.  H.,  and  Kristjanson,  H.  T. :  Jour.  A.  M.  A., 
Dec.  19,  1914. 

'1  Fox,  H.:  Arch.  Int.  Med.,  Sept.,  1915. 


118  CHARLES    C.    W.    JUDD 

was  recovered.  The  lymph  glands  and  spleen  were  not  enlarged, 
nor  was  any  growth  obtained  from  the  spleen  on  culture  or.  in  smear. 

Indeed  the  finding  of  diphtheroid  organism  in  normal  as  well  as 
pathological  lymph  glands  of  numerous  cases  by  Bloomfield'^  and 
others,  has  cast  no  small  doubt  upon  the  pathogenicity  of  the  or- 
ganism in  question.  The  paucity  of  experimental  success  in  animal 
inoculation,  the  recovery  of  the  organism  from  healthy  tissue  and 
the  diversity  of  the  lesions  from  which  the  organism  has  been  iso- 
lated, are  points  emphasized  by  the  opponents  of  the  etiological 
role  of  the  corynebacterium.  They  argue  that  the  organism  is 
probably  entirely  saprophitic,  a  normal  inhabitant  of  the  skin  as  is 
the  m.  albus  and  that  the  superficial  lymph  glands  draining  the 
superficial  tissues  frequently  harbor  the  microorganism  and  thus  the 
bacteriological  findings  are  possible.  Granting  that  the  superficial 
lymph  glands  do  thus  act  as  filters  for  superficial  invaders,  this  does 
not  explain  the  findings  of  the  organism  in  so  deep  seated  a  lymph- 
adenoid  gland  as  the  spleen.  Again,  the  argument  of  unsuccessful 
animal  inoculation,  with  the  non-production  of  analogous  lesions 
in  the  experimental  animal  as  in  the  original  host,  is  not  altogether 
conclusive.  This  situation  has  been  encountered  before,  e.g.,  in 
lues  (with  ultimate  success  in  reproducing  typical  lesions)  so  that 
the  methods  of  inoculation  rather  than  a  non-casual  relationship 
may  be  the  explanation  of  inconclusive,  inconstant  and  atypical 
results.  Again,  various  stains  of  the  streptococcus  group  result  in 
different  responses  on  the  part  of  the  infected  host.  Indisputably, 
the  various  corynebacteria  here  under  consideration  are  quite  as 
divergent  in  their  cultural  characteristics  as  are  the  streptococci, 
and  it  is  a  reasonable  supposition  that  just  as  the  defensive  reactions 
against  the  different  stains  of  streptococci  vary,  likewise  divergent 
tissue  reactions  may  be  manifested  in  the  structures  invaded  by  the 
diphtheroids,  giving  rise  to  the  clinical  varieties  of  disease  lately 
associated  with  this  group  of  corynebacteria. 

The  analog^'  of  the  corynebacteria  and  streptococci  goes  still 
further  in  the  marked  tropism  of  the  former  for  certain  tissues 
(lymph-adenoid  tissue  and  joints).  Finally,  granting  that  they  may 
lead  a  saprophitic  existence  in  the  skin  or  at  times  in  the  superficial 
lymph  glands  (as  does  the  streptococcus  viridans  in  the  mouth  and 
tonsil)  they  are  none  the  less  fairly  constantly  found  associated 

'*  B'.oomfield,  Arthur:  Arch.  Int.  Med.,  Aug.,  1915. 


r6le  of  certain  diphtheroid  microorganisms         119 

with  definitely  pathological  tissue  in  the  disease  enumerated  just  as 
streptococcus  viridans  is  in  malignant  endocarditis  and  certain 
arthritic  conditions,  a  fact  emphasized  particularly  by  Rosenow 
and  his  followers. 

The  time  is  probably  not  ripe  for  the  dogmatic  assertion  that 
these  diphtheroid  organisms  are  the  causative  agent  of  Hodgkin's 
disease,  leukaemia,  Banti's  disease,  lymphosarcoma,  certain  forms 
of  arthritis  and  so  on,  and  probably  can  not  be  seriously  considered 
so,  until  experimental  data  vindicates  the  assertion.  The  findings 
-enumerated  are,  however,  sufficiently  suggestive  to  warrant  not 
less  than  an  open  mind  in  the  consideration  of  the  evidence  now- 
available.  Extensive  investigation,  comprising  particularly  the 
experimental  inoculation  of  monkeys  and  other  animals,  is  requi- 
site before  the  aetiological  role  of  this  interesting  group  of  organisms 
can  either  be  refuted  or  accepted  as  final. 


BULLETIN 

OF    THE 

University  gf  Maryland  School  of  Medicine 

AND 

College  of  Physicians  and  Surgeons 


Publication  Committee 

Randolph  Winslow,  A.M.,  M.D.,  LL.D.  Wm.  S.  Gabdnbr,  M.D. 

J.  M.  H.  Rowland,  M.D. 

Nathan  Winslow,  A.M.,  M.D.,  Eiilor 

Associate  Editors 

Albbrt  H.  Carroll,  M.D.  Andrew  C.  Gillis,  A.M.,  M.D. 

John  Evans,  M.D. 


Death    of   Miss   Louisa   Parsons — A   Nightingale   Nurse 

On  November  23,  the  following  notice  appeared  in  the  Baltimore 

Sun. 

A  cable  has  come  from  Sir  William  Osier,  London,  announcing  that  Miss 
Louisa  Parsons  died  November  2. 

Miss  Parsons  was  born  in  England  and  lived  there  all  her  early  life.  She 
was  trained  as  a  nurse  in  St.  Thomas'  Hospital,  London,  where  she  studied 
under  Florence  Nightingale.  In  1882  she  accompanied  Lord  Wolseley's  Egyp- 
tian expedition  as  an  army  nursing  sister,  receiving  a  medal  from  the  Khedive, 
and  on  her  return  was  decorated  by  Queen  Victoria  with  the  Royal  Red 
Cross.  Contracting  typhoid  fever  from  the  expedition,  Miss  Parsons  came  to 
America  after  her  recovery  as  a  restful  change. 

At  Baltimore  she  helped  to  start  the  Johns  Hopkins  Hospital  in  1889,  and 
later  opened  and  conducted  the  University  of  Maryland  Training  School  for 
Nurses,  where  they  still  wear  the  Nightingale  cap  that  she  introduced.  Miss 
Parsons  was  said  to  be  the  only  Nightingale  nurse  in  America.  She  also 
helped  Clara  Barton  in  the  relief  work  after  the  Beaufort,  S.  C,  flood.  In 
1898,  Miss  Parsons  volunteered  as  nurse  in  the  Spanish-American  War,  and 
it  was  while  stationed  at  Fort  McPherson  that  she  was  called  away  by  ill- 
ness at  home  in  England.  Later,  with  her  tireless  energy.  Miss  Parsons  en- 
tered the  nursing  service  of  the  British  Armj^  in  the  Boer  War  and  served  there 
from  1899  to  1902. 

After  the  close  of  the  war. Miss  Parsons  returned  to  America,  where  she 
had  a  circle  of  friends.  Again  called  home,  she  nursed  her  sister  through  a 
lingering  illness.  Her  friends  were  urging  Miss  Parsons  to  return  to  America, 
but  she  would  not  desert  the  household,  and  there  she  remained  when  the  pres- 
ent war  broke  out.  Then  came  her  pathetic  longing  to  go  and  nurse  the  sol- 
diers, but  her  health  had  begun  to  fail  and  she  wrote  that  she  had  to  content 
herself  with  providing  pleasures  for  the  poor  "Tommies"  in  her  neighborhood. 

120 


EDITORIALS  121 

To  physicians  and  nurses  who  were  connected  with  the  Univer- 
sity Hospital,  a  quarter  of  a  century  ago,  the  announcement  of  the 
death  of  Miss  Parsons  will  be  a  matter  of  melancholy  interest  and 
regret.  As  stated  above,  Miss  Parsons  organized  the  Training  School 
for  Nurses  of  the  University  Hospital  and  was  its  first  superintend- 
ent of  nurses.  She  only  served  two  years  but  she  placed  the 
school  on  a  firm  foundation  and  the  nurses  who  were  trained  by  her 
were  among  the  best  that  have  been  graduated  from  the  institution. 
We  consider  ourselves  fortunate  in  having  had  her  as  the  organizer 
of  the  training  school.  She  was,  however,  an  Englishwoman  who 
could  not  understand,  or  adapt  herself  to,  the  American  point  of 
view  and  she  had  many  unhappy  experiences  in  consequence  thereof. 
Most  of  those  who  were  associated  with  her  in  the  work  at  the 
University  Hospital  in  1890-92  have  passed  away,  but  those  who 
remain  will  always  remember  Miss  Parsons  as  a  forceful  and  efficient, 
though  somewhat  peculiar,  person. 

Through  the  courtesy  of  the  Baltimore  ^Sun  we  are  able  to 
present  the  excellent  portrait  of  Miss  Parsons  which  forms  the 
frontispiece  of  this  issue. 

National  Board  of  Medical  Examiners 

About  the  last  work  of  Dr.  William  L.  Rodman,  before  his  un- 
timely and  greatly  deplored  death,  was  the  founding  of  the  National 
Board  of  Medical  Examiners.  With  great  zeal  and  industry  he  suc- 
ceeded in  organizing,  and  in  securing  financial  support  for,  this  body. 

In  common  with  all  those  who  have  been  concerned  with  medical 
education  for  the  past  twenty  years  Dr.  Rodman  recognized  the 
great  confusion  and  injustice  entailed  on  m_edical  graduates  by  the 
multiplicity  of  examining  boards,  with  diverse  requirements.  Al- 
most every  state  in  the  union  has  its  medical  examining  board  and 
some  have  several,  of  different  degrees  of  inefficiency.  What  is 
needed  in  this  country  is  a  central  board  whose  certificates  shall  be 
recognized  in  all  parts  of  the  United  States  and  its  dependencies. 
The  present  board  is,  however,  a  voluntary  one,  and  its  certificates 
do  not  carry  the  right  to  practice  except  as  a  matter  of  courtesy 
from  the  individual  state  boards.  A  start,  however,  has  been  made 
in  the  right  direction  and  we  believe  this  National  Board  of  Medical 
Examiners  will  have  a  field  of  ever  enlarging  usefulness. 

The  first  examination  was  held  in  Washington,  D.  C.  from  Octo- 


122  EDITORIALS 

ber  16  to  21.  The  examinations  were  rigid  and  were  written,  oral 
and  practical,  in  the  wards  of  hospitals  and  in  the  Government 
laboratories.  Dr.  Herbert  Harlan  of  Baltimore,  class  of  1879, 
University  of  Maryland,  formerly  demonstrator  of  anatomy  in  his 
ahna  mater,  is  the  examiner  on  anatomy  and  on  eye  and  ear  dis- 
eases and  from  training  and  long  experience  is  admirably  equipped 
for  his  position.  Surgeon-General  Rupert  Blue,  class  of  1892,  is 
also  a  member  of  the  board  but  probably  took  no  direct  part  in  the 
examination . 

There  were  thirty-two  applicants  from  seventeen  states,  repre- 
senting twenty-four  medical  schools,  and  of  these  sixteen  were 
accepted  as  having  the  necessary  preliminary  and  medical  qualifi- 
cations, ten  of  whom  took  the  examination. 

The  following  men  passed:  Dr.  Harry  Sidney  Newcomer,  Johns 
Hopkins  University;  Dr.  William  White  Southard,  Johns  Hopkins 
University;  Dr.  Orlow  Chapin  Snyder,  University  of  Michigan; 
Dr.  Thomas  Arthur  Johnson,  Rush  Medical  School;  Dr.  Hjorleifur 
T.  Kristjanson,  Rush  Medical  School. 

Of  ten  applicants  five  passed  and  five  failed. 

The  following  schools  were  represented:  Rush,  two  passed  and  two 
failed;  Hopkins,  two  passed  and  one  failed;  Michigan,  one  passed; 
Bellevue,  one  failed;  Howard,  one  failed. 

We  consider  this  examination  a  very  important  event  and,  con- 
sequently, have  devoted  m.ore  attention  to  it  than  the  number  of 
those  who  took  it  would  seem  to  justify.*  We  would  recommend 
those  having  the  necessary  requirem.ents  to  take  this  examination 
but  it  will  be  useless  for  triflers  and  blockheads  to  do  so. 

The  next  examination  will  be  held  in  Washington,  D.  C.  in  June, 
1917. 

David  Streett  Memorial  Scholarship 

We  have  received  a  letter  from  a  graduate  of  the  Baltin.ore 
Medical  College  inquiring  what  we  are  doing  about  this  scholar- 
ship. Unfortunately  we  have  not  been  doing  much  in  regard  to  it 
for  some  time  for  various  reasons;  one  of  which  is  the  disturbed 
conditions  of  this  country  owing  to  the  European  War  and  the 
Mexican  im.broglio.  We  have  not  forgotten  the  project,  however, 
and  shall  renew  our  efforts  to  collect  money  for  this  purpose.  We 
have  to  confess  that  the  lack  of  response  from  the  form.er  associates 
of  Dr.  Streett  and  from  the  alumni  of  the  Baltimore  Medical  Col- 


ITEMS  123 

lege  has  somewhat  dampered  our  enthusiasm  and  this,  with  the 
pressure  of  other  duties,  has  caused  somewhat  of  a  halt  in  our 
efforts. 

The  following  cash  contributions  have  come  to  hand  since  our 
last  report: 

Jas.  M.  H.  Rowland,  Baltimore $25 .  00 

N.  P.  Barnes,  Washington,  D.  C 10.00 

W.  W.  Eichelberger,  Rockford,  111 1 .00 

$36.00 

Contributions  will  be  welcome  from  any  source  but  the  graduates 
of  the  B.  M.  C.  are  especially  invited  to  subscribe  to  the  fund. 

ITEMS 

Waichiro  Okada,  M.D.,  Professor  of  Oto-Laryngology  in  the  Im- 
perial University,  Tokio,  and  Yugoro  H.  Honda,  M.D.,  Tokio, 
visited  Mercy  Hospital,  November  22  and  University  Hospital, 
November  23. 

Thomas  P.  Lloyd,  M.D.,  B.  M.  C.  '96,  is  president  of  the  High- 
land Sanitarium  Company,  which  is  building  a  sanitarium  at 
Shreveport,  La. 

Frank  H.  Walke,  M.D.,  B.  M.  C.  '12,  of  Shreveport,  La.,  was  a 
recent  visitor  at  the  University. 

J.  Ashton  Blanchard,  M.D.,  C.  P.  &  S.  '97,  who  is  engaged  in  eye 
work  in  Shreveport,  La.,  has  returned  to  this  country  after  a  visit 
to  Europe. 

Dr.  A.  J.  Otto,  C.  P.  &  S.  '99,  Sanborn,  Minn.,  is  visiting  Mercy 
Hospital. 

Dr.  J.  E.  Marschner,  C.  P.  &  S.  '11,  Wheeling,  W.  Va.,  is  follow- 
ing the  clinics  at  Mercy  Hospital  for  a  few  days. 

Dr.  W.  E.  McGinley,  C.  P.  &  S.  '13,  who  has  been  located  at  the 
State  Hospital,  Warm  Springs,  Mont.,  since  his  graduation,  recently 
resigned  his  position  and  returned  East.  He  has  been  spending  a 
few  days  at  Mercy  Hospital  and  expects  to  locate  in  New  London, 
Conn. 


124  ITEMS 

E.  Van  Hood,  M.D.,  Ocala,  Fla.,  recently  visited  the  Mercy  and 
University  Hospitals.  Dr.  Van  Hood  was  graduated  from  the  College 
of  Physicians  and  Surgeons,  class  of  1884,  his  preceptor  being  Prof. 
John  W.  Chambers.  He  was  first  honor  man  in  his  class  of  one 
hundred  and  thirty-seven,  and  winner  of  the  Cathell  and  W.  H. 
Bobbitt  prizes.  After  his  graduation  he  spent  the  year  1884-1885 
as  interne  in  St.  Joseph's  Hospital,  this  city.  The  following  year, 
1885-1886  he  served  as  senior  house  surgeon  at  Mercy  Hospital. 
After  he  completed  this  service  he  located  at  Ocala,  Fla.,  and  en- 
gaged in  general  practice.  When  the  yellow  fever  epidemic  oc- 
curred in  Jacksonville,  Fla.,  1887,  the  state  called  for  volunteers  to 
combat  this  disease.  Dr.  Van  Hood  was  one  of  the  first  to  volun- 
teer. While  engaged  in  this  work  he  was  stricken  with  the  dis- 
ease and  after  recovering  he  returned  to  his  home  to  continue  his 
work.  At  the  outbreak  of  the  Spanish-American  War,  he  enlisted 
in  the  medical  service  of  the  United  States  Arro.y.  Shortly  after 
this  enlistment  a  call  was  sent  out  for  men  im.mune  to  yellow  fever 
which  was  epidemic  in  Cuba.  Dr.  Van  Hood  again  volunteered 
and  served  at  Santiago.  He  remained  in  the  service  of  the  United 
States  Army  until  1901,  after  which  he  returned  to  his  home  at 
Ocala,  Fla.,  since  which  time  he  has  given  special  attention  to  the 
practice  of  surgery. 

Dr.  C.  H.  Halliday,  C.  P.  &  S.  '04,  is  superintendent  of  the  Zam- 
boanga  General  Hospital,  Zamboanga,  P.  I.  Dr.  Halliday  will 
visit  the  United  States  early  in  1917  and  will  attend  the  clinics  at 
Mercy  Hospital. 

Married. — Perry — Booth. — At  the  residence  of  Mrs.  Hugh  Ca- 
perton,  No.  916  Newington  avenue,  at  4  p.m.,  Wednesday,  Novem- 
ber 15,  Mrs.  N.  N.  Booth,  of  Norfolk,  Va.,  and  Dr.  J.  C.  Perry, 
Public  Health  Service,  of  New  York. 

Dr.  James  C.  Perry  graduated  at  the  University  of  Maryland 
in  1885  and  has  been  a  distinguished  member  of  the  Public  Health 
Service  for  many  years.  For  about  ten  years  he  was  stationed 
on  the  Isthmus  of  Panama  and  was  the  health  officer  of  Panama. 
We  extend  our  congratulations  and  best  wishes  to  him. 

We  are  glad  to  announce  that  all  the  University  of  Maryland 
students  who  took  the  Porto  Rican  Examining  Board  this  summer 
were  successful  in  passing  their  examinations. 


i 


ITEMS  125 

The  contention  between  the  medical  and  law  departments  of  the 
University  of  Maryland  over  the  control  of  Terra  Mariae,  the  an- 
nual publication  of  the  university,  has  been  settled.  At  a  meeting 
held  recently,  at  which  Provost  Fell  presided,  it  was  decided  that 
the  two  editors-in-chief  as  elected  by  the  two  departments  should 
have  concurrent  jurisdiction,  assisted  by  an  editorial  board  from  the 
dental  and  pharmacy  departments,  in  the  affairs  and  publication  of 
the  annual  book. 

Dr.  William  Gombel  died  on  November  29,  1916,  at  his  home, 
1704  Madison  avenue,  of  cancer  of  the  throat,  with  which  he  was 
stricken  early  last  June.  He  was  bom  in  Germany;  sixty-two  years 
ago  and  came  to  this  country  when  seventeen  years  old.  He  studied 
at  the  College  of  Physicians  and  Surgeons  and  graduated  at  the 
head  of  his  class  in  1877. 

Surviving  him  are  his  widow,  Mrs.  Emma  Marie  Gombel;  a 
daughter,  Mrs.  Minna  Gombel  Rumsey,  and  three  brothers  who  are 
fighting  for  Germany.  Mrs.  Rumsey  was  filling  an  engagement 
as  leading  woman  with  one  of  the  Henry  Savage  companies  in 
Cleveland,  Ohio,  when  she  was  summoned  to  her  father's  bedside. 

Dr.  William  L.  Smith,  a  prominent  physician  of  Baltimore  county, 
died  on  November  28,  1916,  from  a  complication  of  diseases  at  his 
home  at  Riderwood,  after  being  in  ill-health  for  two  years. 

Born  in. Calvert  county.  Dr.  Smith  was  a  son  of  the  late  Fielder 
Bowie  and  Rebecca  B.  Smith.  He  was  fifty-three  years  eld.  He 
received  his  early  education  at  the  Maryland  State  College  and. 
after  his  graduation,  entered  the  College  of  Physicians  and  Sur- 
geons, Baltimore,  and  was  graduated  in  1887. 

Dr.  Smith  took  up  the  practice  of  medicine  at  Jarrettsville,  Har- 
ford county,  where  he  remained  seventeen  years.  He  then  moved 
to  Riderwood.  He  was  a  past  master  of  Mount  Moriah  Lodge  of 
Masons,  of  Towson,  a  member  of  the  Medical  and  Chinirgical 
Faculty  of  Maryland,  and  a  former  president  of  the  Baltimore 
County  Medical  Association.  He  was  also  the  family  physician  of 
Congressman  Talbott. 

Dr.  Smith  married  Miss  Eleanor  Owens  Smith,  daughter  of  the 
late  Dr.  John  S.  and  Ruth  Eleanor  Smith,  who,  with  two  children,. 
William  Franklyn  and  Miriam  Lee  Smith,  survive  him. 


126  DEATHS 

At  the  factory  of  the  H.  H.  Franklin  Manufacturing  Co.,  Syra- 
cuse, N.  Y.,  a  hospital  for  treating  first  aid  and  even  more  serious 
surgical  cases  among  the  workmen  has  just  been  opened.  It  is  in 
charge  of  Dr.  Myles  D.  Sharkey,  a  graduate  of  the  University  of 
Maryland,  class  of  1915. 

Dr.  Elmer  Newcomer,  superintendent  of  the  Maryland  General 
Hospital,  was  elected  vice-grand  regent  of  the  Kappa  Psi  Frater- 
nity, the  second  highest  office  in  the  organization,  at  its  national 
convention  in  Atlanta,  Ga.,  last  week,  which  he  attended.  He  also 
took  in  the  sessions  of  the  Southern  Medical  Association,  which  were 
held  there  about*  the  same  time.  Dr.  Newcomer  has  returned  and 
resumed  his  duties  at  the  hospital. 

Dr.  Newcomer  is  a  graduate  of  the  University  of  Maryland, 
class  of  1913,  and  after  serving  as  assistant  resident  surgeon  for 
three  years  and  assistant  superintendent  at  the  University  Hos- 
pital, was  appointed  medical  superintendent  of  the  Maryland 
General  Hospital. 

Dr.  R.  Arthur  Hungerford,  who  was  a  graduate  of  the  first  den- 
tal class  of  the  University  of  Maryland  and  one  of  the  best- known 
members  of  the  profession  in  this  city  up  to  18  years  ago,  when  he 
retii'ed,  died  at  his  home,  Rogers  Avenue  and  South  Bend,  Mount 
Washington.  He  had  been  in  ill  health  for  some  years,  but  was 
confined  to  his  home  only  for  the  last  month. 

Dr.  William  Tarun  announces  the  removal  of  his  office  to  605 
Park  Avenue,  Baltimore,  Maryland,  on  December  1,  1916. 

DEATHS 

Percy  Guy  Davis,  M.D.,  Deerfield,  Mass.,  B.  M.  C.  '96;  aged  49; 
a  member  of  the  Massachusetts  Medical  Society;  for  several  years 
president  of  the  Deerfield  Village  Improvement  Society;  died  in  his 
office,  October  20,  from  heart  disease. 

Charles  P.  Bigelow,  M.D.,  Grand  Rapids,  Mich.,  C.  P.  &  S., 
Baltimore  '82;  aged  92;  a  veteran  of  the  Civil  War;  for  many  years 
a  druggist;  died  in  Blodgett  Memorial  Hospital,  Grand  Rapids, 
October  14. 


BOOK   REVIEWS  127 

Henry  H.  Whitaker,  M.D.,  Hilliardston,  N.  C,  U.  of  M.  '83; 
aged  55;  formerly  a  member  of  the  Medical  Society  of  the  State  of 
North  Carolina;  died  at  his  home,  October  12,  from  cerebral 
hemorrhage. 

Louis  Edward  Gott,  M.D.,  Falls  Church,  Va.,  U.  of  M.,  '61; 
aged  76;  a  member  of  the  Medical  Society  of  Virginia;  surgeon  of 
the  Forty-Ninth  Virginia  Regiment  and  the  Twenty-First  Georgia 
Regiro.ent  during  the  Civil  War;  died  in  Georgetown  University 
Hospital,  Washington,  October  29,  from  prostatic  disease. 

Lynn  A.  Pickering,  M.D.,  Aberdeen,  S.  D.,  B.  M.  C.  '98;  aged 
46;  a  Fellow  of  the  American  Medical  Association;  is  believed  to 
have  been  drowned  while  hunting,  near  Aberdeen,  November  3. 

Edward  Lummis  Diament,  M.D.,  Bridgeton,  N.  J.,  B.  M.  C.  '97; 
aged  44;  died  at  his  home,  August  2,  from  heart  disease. 

BOOK  REVIEWS 

A  Manual  of  Nervous  Diseases.  By  Irving  J.  Spear,  M.D.,  Pro- 
fessor of  Neurology  in  the  University  of  Maryland,  Baltimore, 
Md.  With  172  illustrations.  1916.  W.  B.  Saunders  Com- 
pany.    Philadelphia  and  London. 

It  gives  us  great  pleasure  to  welcome  this  work  on  nervous  dis- 
eases by  Prof.  Irving  J.  Spear  of  our  own  medical  school.  The  book 
is  not  a  compendious  treatise  on  this  subject  but,  as  expressed  by 
the  author,  aims  "to  embody  in  a  book  of  moderate  size  the  facts 
necessary  for  a  proper  understanding  of  the  anatomy,  the  physiology, 
and  the  diseases  of  the  nervous  system." 

The  first  141  pages  of  the  book  are  devoted  to  the  study  of  the 
anatomy  and  physiology  of  the  nervous  system,  which  is  the  founda- 
tion upon  which  all  must  build  who  would  master  this  intricate  sub- 
ject. Dr.  Spear  claims  that  the  study  of  the  diseases  of  the  nervous 
system  is  not  difficult  but  most  of  us  will  hardly  agree  with  him  in 
this  opinion.  Certainly  one  will  find  it  difficult  who  does  not  mas- 
ter the  essentials  of  the  structure  and  function  of  the  central  nervous 
organs.  We  would  therefore  commend  a  careful  study  of  this  por- 
tion of  the  work  as  a  preliminary  to  the  more  interesting  chapters 
on  disorders  of  the  nervous  system.     The  method  of  examination  of 


128  BOOK   REVIEWS 

patients  suffering  with  nervous  diseases  is  described  in  detail,  though 
not  in  a  highly  technical  manner.  The  actual  description  of  dis- 
ease conditions  takes  up  about  450  pages,  and  though  concise  ap- 
pears to  be  sufficiently  comprehensive.  Many  subjects  of  general 
interest  are  discussed,  such  as  tetanus,  spinal  injuries,  injuries  of 
the  peripheral  nerves  and  brain  tumors,  from  which  discussion  the 
general  practitioner  and  surgeon  may  equally  derive  instruction. 
This  is  not  intended  to  be  a  critical  review,  as  the  writer  is  not  a 
neurologist  and  does  not  feel  competent  to  do  more  than  record  his 
impressions  of  the  book.  It  looks  good  to  us ;  it  is  well  illustrated, 
largely  from  cases  at  the  University  and  Bay  View  Hospitals.  It 
is  a  neat  and  compact  volume,  of  a  size  suitable  for  ready  refer- 
ence, and  we  believe  it  will  find  a  field  of  usefulness  that  a  larger 
work  would  not  serve.  R.  W. 


4t^ — ^^^Cr'Z^^'-^H 


The  Original  Painting  is  to  be  Found  in  the  Picture  Gallery  at 
Frederiksborg  Castle  about  20  Miles  North  of  Copenhagen 


BULLETIN 

OF  THE 

University  of  Maryland  School 
OF  Medicine 

AND 

College  of  Physicians  and 
Surgeons 

Successor  to  The  Hospital  Bulletin,  of  the  University  of  Maryland, 
Baltimore  Medical  College  News,  and  the  Journal  of  the  Alumni  Asso- 
ciation of  the  College  of  Physicians  and  Surgeons 

Vol.  I  JANUARY,  1917  No.  6 

THOMAS  BARTHOLIN 
1616-1916 

By  Ejnar  Hansen,  M.D.^ 

Neiv  York 

The  300th  anniversary  of  the  birth  of  Thomas  BarthoHn,  the  well 
known  scientist  and  anatomist,  has  just  been  celebrated. 

On  October  22,  1916,  a  distinguished  assemblage  of  physicians,, 
surgeons  and  laymen,  from  all  Scandinavia,  collected  in  the  lai'ge 
auditorium  of  the  Royal  University  of  Copenhagen  to  pay  homage 
to  the  memory  of  the  man  whose  name  means  so  much  in  the  his- 
tory of  medicine  and  surgery.  Dr.  Vilhelm  Maar  of  Copenhagen 
was  the  principal  speaker  at  the  memorial  exercises  and  the  follow- 
ing extract  from  his  speech  may  be  of  interest  to  the  reader. 

In  April,  1616,  William  Harvey  delivered  in  London  his  epoch-making 
lectures  declaring  that  the  blood  moves  in  a  circle;  thereby  with  one  stroke 
revolutionizing  the  whole  theory  of  medical  science  that  had  insisted  for 
fourteen  hundred  years,  since  the  time  of  Claudius  Galenus,  that  the  blood 
left  the  left  side  of  the  heart,  was  distributed  to  the  arteries  and  from  there 
never  came  back. 

Six  months  after  Harvey's  discovery,  on  October  22,  1616,  Thomas 
BarthoUn  was  born  in  Copenhagen.     His  father  was  Casper  Bar- 


k 


i.Class  of  1904. 

129 


130  EJNAR   HANSEN 

tholin,  professor  of  medicine  at  Copenhagen  University,  his  maternal 
grandfather  was  Thomas  Finke,  also  professor  of  medicine  at  the 
University. 

Thomas  Bartholin  was  indeed  born  in  an  epoch  making  century; 
when  he  was  six  years  old  Gasparo  Aselli  discovered  the  chjde  ves- 
sels; when  he  was  twenty-five  years  of  age  Moritz  Hoffman  and 
Georg  Wirsung  found  the  exit  of  the  glands  in  the  stomach;  seven 
years  later  Johannes  van  Helmonts  printed  his  important  works  on 
experimental  physiology;  all  through  his  life  great  discoveries  were 
being  made  in  medicine  and  surgery:  Marcello  Malphigi,  the  capil- 
laries; Jean  Pecquet  and  Johannes  van  Home,  the  ductus  thoraci- 
cus;  Johannes  Svammerdam  the  red  blood  corpuscles;  Anthony  van 
Leeuwenhoek,  the  spermatozoa;  Frans  de  le  Sylvius,  the  aquaeduc- 
tus  Sylvii  and  many  others  too  numerous  to  mention  here. 

In  1637,  when  only  twenty-one  years  old,  Thomas  Bartholin  started 
out  on  his  travels.  He  went  first  to  Holland  "vyhere  he  became  intimate 
with  Sylvius  and  Johannes  Walaeus,  the  latter  was  the  first  on  the 
continent  to  prove  the  correctness  of  Harvey's  statement.  In  Paris 
he  studied  with  Bartholin  Rene  Moreau  and  Guy  Patin.  In  Italy, 
especially  in  Padua  and  Naples,  he  was  closely  connected  with  Johan 
Rodes,  Johannes  Vesling  and  Marco  Aurelio  Severino. 

When  reading  these  names  we  easily  see  that  Bartholin  from  his 
early  youth  felt  himself  drawn  towards  anatomy  and  the  men  whose 
names  were  famous  in  that  branch  of  medical  science.  His  name 
soon  became  well  known  throughout  the  medical  would  and  his  home 
university  began  to  call  him,  but  for  several  years  without  success; 
when  at  last  they  offered  him  the  professorship  in  anatomy  he 
accepted. 

During  the  thirteen  years  he  was  at  the  University  of  Copenhagen 
he  proved  the  existence  of  the  ductus  thoracicus  (1652),  and  in 
1653  he  discovered  the  vasa  lymphatica,  undoubtedly  the  most  im- 
portant step  in  medical  science  of  that  time.  The  year  after,  in  1654, 
he  proved  their  existence  in  the  human  body. 

At  forty-four  years  of  age  he  suddenly  gave  up  all  his  anatomical 
and  physiological  work,  resigned  his  chair  at  the  university  and  re- 
tired to  his  place  in  the  country,  giving  poor  health  as  an  excuse. 
It  is  now  believed  that  as  a  young  man  he  had  pulmonary  tubercu- 
losis and  it  is  known  that  all  his  life  he  suffered  from  stones  in  the 
kidneys.     He  continued  his  literary  work  during  the  twenty  years 


WHY  THE   LIMITATIONS?  131 

he  lived  after  his  retirement  from  the  University,  and  in  the  Univer- 
sity Hbrary  you  will  find  the  most  of  his  voluminous  works. 

The  house  where  Thomas  Barthohn  was  born  has  been  destroyed 
by  fire,  the  house  where  he  lived  as  a  professor  shared  the  same  fate, 
likewise  the  Domus  Anatomica  where  he  worked,  his  place  in  the 
country,  his  library,  and  the  church  where  he  was  buried.  The 
only  portrait  of  him  in  existence  is  the  one  here  reproduced. 

It  seemed  as  though  fate  had  decided  to  destroy  everj^thing  that 
could  remind  us  of  Thomas  Bartholin,  until,  about  eleven  years  ago, 
a  stone  inscribed  with  his  name  was  found  in  an  excavation  near  the 
University.  This  has  been  restored  and  fastened  in  the  wall  of  the 
anatomical  museum  to  perpetuate  the  memory  of  the  man  whose 
works  and  discoveries  three  hundred  years  ago  made  his  own  and 
Denmark's  name  famous  in  the  medical  centers  of  the  world. 

WHY  THE  LIMITATIONS?' 

An  Attempt  to  Answer  the  Editorial  "Our  Limitations"  in 

THE  October  Number  of  the  Bulletin  of  the  Medical 

and  Chirurgical  Faculty  of  Maryland 

By  William  J.  Todd,  M.D. 

Mt.  Washington,  Maryland 

For  the  zeal  of  thine  house  hath  eaten  me  up;  and  the  reproaches  of  them 
that  reproached  thee  are  fallen  upon  me. — Hebrew  Literature. 

In  the  October  number  of  The  Bulletin  of  the  Medical  and  Chirur- 
gical Faculty,  the  official  organ  of  the  State  Medical  Society,  appeared 
an  editorial  bearing  the  title  ''Oui'  Limitations,"  the  fiz'st  line  read- 
ing "Tools  rush  in  where  angels  fear  to  tread'  is  an  old  saying  but 
far  too  true,  and  will  apply  to  many  of  our  fraternity." 

The  Editor  had  no  fear  to  rush  in  with  pen  and  ink  to  criticise 
the  whole  medical  profession,  from  the  county  doctor  at  the  iso- 
lated cross  roads  settlement  to  the  princely  speciaUst  on  Euclid  Ave- 
nue; all  came  in  for  a  share  of  his  censure. 

This  Editor,  I  know  he  is  not  "a.  fool,"  I  am  also  as  positive  he  is 
not  "an  angel,"  adds  a  patriarchal  advice,  I  quote  his  words  of  wis- 
dom, 

1  Read  before  The  Baltimore  County  Medical  Association,  December  20, 
1916. 


L 


132  WILLIAM   J.    TODD 

"But  the  field  is  large,  and  therefore  I  wish  to  direct  your  atten- 
tion to  some  of  the  many  frequent  mistakes  that  permanently  im- 
pair or  destroy  those  most  vital  of  senses,  sight  and  hearing. 

The  last  paragraph  of  this  editorial  reads,  "While  these  faults  are 
not  pleasant  to  face,  it  is  far  better  to  recognize  and  correct  them 
from  within  the  fraternity  than  have  them  brought  to  our  attention 
by  the  laity.     So  again  'let  us  have  team  work.'  " 

While  I  hope  I  am  not  "a,  fool,"  I  know  I  am  not  "an  angel,"  I 
also  know  my  limitations  as  a  speaker  and  as  a  writer;  I  undertake 
in  a  mild  and  lenient  manner  to  protest  against  this  libel — a  Ubel 
more  especially  at  a  time  when  suits  for  malpractice  are  not  a  few. 

The  "motive"  in  writing  this  editorial  has  been  made  clear,  this 
Editor,  "Our  Editor,"  has  a  dream,  a  hobby — "Team  Work  in 
Medicine,"  and  he  would  and  did  libel  the  profession  to  ride  his  hobby 
in  public.  Under  the  control  of  the  Mayo  Brothers,  with  financial 
backing,  with  business  tact,  with  their  medical  and  surgical  skill 
and  with  their  philanthropical  generosity,  "Team  Work"  has  been  a 
success. 

Alas!  what  imitators  we  are,  in  the  hands  of  lesss  capable  men; 
"Our  Editor"  has  told  us  we  were  not  capable  men;  I  fear  "Team 
Work"  would  be  nothing  more  nor  less  than  an  ethical  commercial 
enterprise,  much  to  the  detriment  of  the  patient  and  the  profession 
generally. 

Let  me  quote  the  preamble  to  resolutions  passed  March,  1912,  by 
The  Baltimore  County  Medical  Association. ^ 

Owing  to  the  increased  tendency  upon  the  part  of  some  members  of  the 
medical  profession,  ....  to  criticise,  denounce  and  belittle  other  mem- 
bers of  the  medical  profession  who  may  not  have  had  the  opportunities  for 
special  clinical  work  and  instruction  in  large  hospitals,  and  the  instruction 
and  medical  study  and  advancement  obtainable  onlj^  by  a  residence  in  a  large 
city,  in  an  unjust,  unkind  and  uncharitable  manner,  which  criticism  we  con- 
sider a  detestable  method  of  self -advertising,  and  without  question  the  cause 
of  increasing,  directly  and  indirectly,  the  number  of  malpractice  suits  against 
physicians  and  surgeons. 

Is  this  editorial  an  indication  of  a  return  to  such  measures  of  1912? 
I  hope  not. 

The  advisability  of  "Team  Work"  is  questionable,  and  because 
of  this  objection  the  profession  will  be  slow  to  adopt  these  medical 

^  Maryland  Medical  Journal,  October,  1912. 


WHY   THE    LIMITATIONS?  133 

co-partnerships.  The  medical  profession  is  conservative  and  is  sus- 
picious of  any  innovation  that  savors  of  commercialism. 

The  second  "motive"  is  also  as  clear  and  pronounced  as  is  the 
first,  I  quote,  "and  probably  few  would  believe  that  the  majority  of 
practitioners  refer  their  patients  to  a  mechanic  to  have  a  medical 
survey  of  such  an  important  organ  as  the  eye." 

This  "motive"  is,  in  my  estimation,  as  commercial  as  the  first 
motive.  In  my  experience  the  majority  of  the  general  physicians  do 
not  refer  their  patients  suffering  with  eye  and  ear  troubles  to  a  me- 
chanic, they  have  been  referring  them  to  the  leading  ear  and  eye 
specialists  of  the  city.  For  the  past  five  years  the  patient  in  a  ma- 
jority of  instances  makes  his  own  diagnosis  and  goes  direct  to  an 
ear  and  eye  specialist  of  his  own  selection.  The  damnable  criticism 
of  the  physicians  and  the  medical  profession  generally  of  late  years 
is  now  showing  results,  the  pubHc  has  taken  the  profession  at  its 
word,  at  its  own  estimate  and  as  a  result  we  have  many  semi-scien- 
tific cults,  and  there  are  more  to  follow  the  one  Our  Editor  has 
named. 

If  there  be  any  additional  weak  points  in  the  profession  they  are, 
in  my  humble  opinion.  First.  A  large  amount  of  money  has  been 
appropriated  for  medical  colleges,  hospitals  and  homes  fi*om  year  to 
year.  This  assistance  from  the  state  is  just  and  right  and  should  be 
increased  and  will  be  increased  as  the  years  go  by.  If  I  read  the 
signs  of  the  times  aright  the  State  will  at  some  future  day  of  a 
necessity  assume  full  charge  and  control  of  the  sick  and  injured. 
These  large  sums  of  money  have  been  given  each  year  to  be  dis- 
tributed by  the  medical  men  in  charge  and  justly  and  rightly  so, 
but  alas!  some  have  mistaken  the  trust  placed  in  their  hands  and 
are  reaping  the  benefit  from  increased  opportunities  to  add  to  their 
skill  and  knowledge  and  have  overlooked  the  medical  brother  who 
is  on  the  outside. 

I  estimate  that  of  the  2292  taxpaying  physicians  in  the  state  of 
Maryland  80  per  cent  are  outside  of  and  have  no  connection  with 
hospital,  college  or  home  which  is  receiving  this  "State  Aid." 

Notwithstanding  the  wonderful  forward  march  of  medicine  and 
surgery  in  the  past  decade,  an  evolution  that  has  gone  forward  by 
leaps  and  bounds,  the  general  physician  has  in  as  wonderful  manner 
kept  in  touch  with  this  advance  and  readjusted  himself  so  that, 
while  I  have  no  statistics  to  prove  my  figures,  I  estimate  that  of  the 
natients  brought  to  the  speciaUst  for  consultation  and  operation — 


134  WILLIAM   J.    TODD 

in  75  per  cent  the  diagnosis  of  the  family  physician  is  correct  and  is 
endorsed  by  the  consultant.  In  10  per  cent  the  diagnosis  ot  the 
family  physician  is  not  endorsed  by  the  consultant  and  is  not  cor- 
rect. In  15  per  cent  no  diagnosis  of  the  family  physician  or  of  the 
consultant  has  been  made  before  the  patient  undergoes  an  opera- 
tion or  comes  to  an  autopsy. 

Second.  The  free  clinic  is  not  at  present  worked  up  and  utilized  as 
it  ought  to  be.  There  is  no  good  reason  why  each  professor  having 
a  chair  in  a  medical  college  should  not  have  a  clinic  once  a  week  for 
the  benefit  of  the  general  physicians  of  the  state,  a  free  post  gradu- 
ate work  where  the  general  physician  could  examine  and  assist  in 
operations  under  the  direction  of  the  chief  of  that  special  department. 

When  such  work  is  fully  installed  Om-  Editor  may  criticise  the 
general  physician  to  his  hearts  content  and  I  will  give  him  my  en- 
dorsement. 

Third.  A  number  of  years  ago  the  Medical  and  Chirurgical  Fac- 
ulty reorganized  and  developed  under  The  Baltimore  City  Medical 
Society  seven  special  sections  in  which  the  specialist  would  meet  his 
fellow-specialist  and  tell  him  what  he,  the  fellow,  aheady  knew. 
The  general  physician  might  attend  these  meetings  or  sections  but 
the  truth  is  and  experience  proved  that  he  did  not,  the  general  physi- 
cian who  was  anxious  for  this  special  knowledge  and  the  acquaint- 
ance, personal  contact  and  advice  of  men  doing  special  work  was 
denied  all  the  special  advantage  of  this  contact.  The  special  sec- 
tion proved  a  failure  and  the  Old  Clinical  Society  features  were  re- 
sumed about  two  years  ago,  yet  notwithstanding  this  return  to 
first  principles  enthusiasm  is  markedly  absent  and  inertia  is  the 
order  of  the  usual  general  meeting,  unless  something  unusual  is  on 
the  program  or  some  great  man  appears.  One  of  the  seven  sections 
has  evolved  to  an  independent  society  into  which  only  the  elect  will 
be  admitted  as  members. 

Our  Editor  is  one  of  a  number  who  has  attained  to  a  more  or  less 
prominence  in  the  profession  who  seems  determined  to  discredit  the 
medical  profession  in  the  eyes  of  the  pubHc  in  expressions  of  hysteri- 
cal pessimism  and  religious-Hke  self-debasement. 

Let  us  take  a  common  sense  view  of  conditions.  The  medical  pro- 
fession is  not  going  to  the  dogs,  its  members  are  good,  clean  men, 
working  for  their  personal  development,  the  welfare  of  themselves 
and  their  famiHes.  They  have  at  heart  the  interests  of  their  patients, 
not  to  exploit  the  sick  and  afflicted  that  come  for  medical  care. 


TWO   INTERESTING   CASES   OP   MYXEDEMA  135 

Doing  all  this  for  a  low  wage,  a  pittance  when  the  average 
annual  income  of  the  medical  man  is  compared  with  the  average 
annual  income  of  business  men  doing  work  requiring  less  attention 
and  skill.  They  should  have,  many  have,  a  few  have  not,  love  for 
their  medical  brother  at  heart  and  seek  and  strive  for  the  protection 
and  welfare  of  the  profession. 

A  great  evolution  has  come  upon  us,  and  while  we  are  readjusting 
ourselves  and  our  conditions  and  smToundings  let  us  have  the  good- 
ness of  heart  to  take  our  medical  brother  by  the  hand  and  lead  him 
kindly,  gently,  on  to  greater  truths,  nobler  achievements  and  attain- 
ments. • 

Let  me  repeat  the  lines  from  the  Hebrew  poet:  "For  the  zeal  of 
thine  house  hath  eaten  me  up;  and  the  reproaches  of  them  that  re- 
proached thee  are  fallen  upon  me." 

REPORT  OF  TWO  INTERESTING  CASES  OF  MYXEDEMA 
IN  THE  SAME  FAMILY 

By  Dr.  E.  F.  RaphelI 
Cumberland,  Maryland 

Myxedema  is  a  chronic  disorder  of  the  thyroid  body  in  which 
there  is  more  or  less  decrease  of  its  physiological  function.  It  is 
characterized,  clinically,  by  changes  in  the  physical  and  mental 
condition  of  the  affected  individual.  The  degree  of  these  changes 
depends  on  the  extent  and  the  age  at  which  the  disease  appears. 

Myxedema  or  athyrosis  is  divided  into  two  forms,  the  sporadic 
and  the  endemic.  The  sporadic  are  athyrosis  congenita,  athyrosis 
acquisita  and  cachexia  strumipriva  (operative). 

The  endemic  form  or  true  cretinism  is  the  form  which  is  found 
most  frequently  in  certain  regions  and  families. 

The  symptoms  of  myxedema  depend  upon  the  age  at  which  the 
disease  occurs.  In  those  cases  occmTing  in  the  early  months  of 
life  there  is  a  marked  lack  of  development  of  the  body  which  becomes 
unshapely;  the  head  is  large  in  proportion  to  the  rest  of  the  body; 
fontanels  remain  open;  the  hair  dry  and  sparse;  the  fingers  and  toes 
are  broad  and  clrnnsy;  there  is  a  thickness  and  doughy  swelling 
in  the  connective  tissues;  the  teeth  are  erupted  late;  the  abdomen 
distended;  the  complexion  sallow,  eyes  puffed,  nose  small,  mouth 

1  Class  of  1906. 


136  E.    F.    RAPHEL 

large,  lips  thick,  tongue  protruded  and  seems  too  large  for  the  mouth. 
The  intellectual  development  is  slow  and  deficient.  These  patients 
do  not  learn  to  walk  until  late  and  then  often  with  difficulty. 

In  those  cases  in  which  the  disturbances  of  the  th>Toid  takes 
place  later  in  life,  the  general  phj'sical  distui'bances  are  not  so  marked. 
There  is  usually  a  doughy  deposit  in  the  subcutaneous  tissues,  par- 
ticularly beneath  the  clavicles,  in  the  abdominal  walls,  etc.  The 
face  often  becomes  expressionless;  the  hair  dry  and  coarse,  and  at 
times  there  is  a  falling  out  of  the  hair  and  the  eyebrows.  Intel- 
lectually, the  changes  range  from  mental  slowness  to  almost  a  com- 
plete dementia.  The  temperature  is  usually  sub-iformal;  there  is  a 
decrease  in  the  hemoglobin  and  the  blood  pressm'e  is  often  below 
normal. 

The  following  is  the  history  of  two  cases  that  are  now  imder 
treatment  and  that  occurred  in  a  family  in  which  several  other 
members  were  similarly  affected.  This  family  came  originally 
from  England,  and  as  far  as  I  could  ascertain  there  had  been  no 
similar  disease  in  the  preceding  generations  nor  do  they  come  from 
a  region  where  cretinism  is  endemic. 

Family  history.  Father  died  of  cancer  of  face,  age  73.  Mother 
died  with  jaundice,  age  72;  there  were  sixteen  children  in  the  family; 
one  brother  and  two  sisters  died  with  scarlet  fever;  one  brother 
typhoid  fever;  one  sister  of  nephritis,  age  52;  several  children  died 
dming  infancy,  cause  unknown. 

CASE  1 

K.  M.  Married,  age  28;  two  childi'en;  a  boy  who  is  living  and  in 
good  health;  a  girl  who  was  a  cretin  and  died  at  age  of  six  years  with 
pneumonia.  Eight  years  ago  had  an  attack  of  jaundice  which 
lasted  three  months;  seven  years  ago  had  an  attack  of  intestinal 
trouble  with  hemorrhages  which  lasted  several  months.  Following 
this  she  became  very  constipated  which  has  been  continuous  up  to 
the  present  time  and  has  given  her  considerable  .trouble. 

Present  illness.  Following  her  attack  of  intestinal  trouble,  this 
was  seven  years  ago,  she  noticed  the  skin  of  her  arms  began  to  get 
sallow,  dry,  scaly  and  rough;  a  j'ear  later  her  hair  began  to  get  dry 
and  coarse  and  fell  out;  this  was  particularly  noticeable  in  the 
axillary  spaces,  which  finally  became  hairless.  About  two  years 
ago  the  eyelids  began  to  puff,  lids  became  thick,  the  voice  hoarse, 
the  nails  brittle,  the  skin  very  dry.     She  complained  principally  of 


TWO    INTERESTING   CASES   OF   MYXEDEMA  137 

feeling  cold;  of  a  gradual  increase  of  weight,  with  a  loss  of  strength 
and  energy.  Physical  examination  shows  the  patient  to  be  pale 
and  sallow;  the  hair  is  dry  and  brittle;  the  eyelids  puffed;  the  face 
expressionless.  Conjunctiva  are  pale;  the  neck  is  thick;  brown 
pigmented  spots  are  found  on  the  side  of  face,  the  neck  and  extensor 
surfaces  of  both  forearms;  the  voice  is  hoarse;  subcutaneous  thick- 
ening is  widespread,  being  most  noticeable  over  abdomen,  legs  and 
supra-clavicular  fossa.  This  subcutaneous  thickening  does  not  pit 
on  pressure;  the  nose  is  broadened;  the  lips  and  tongue  seem  to 
be  swollen  and  enlarged;  the  tongue  is  coated;  the  hair  absent  in 
the  axillary  spaces;  the  skin  is  scaly,  rough  and  cold,  the  finger  tips 
blue,  nails  brittle;  menstruation  normal;  the  eyes  react  normally 
to  light;  the  deep  reflexes  are  all  normal;  Romberg's  sign,  negative; 
pulse  is  60  per  minute;  temperature  97;  respiration  20;  blood  pres- 
sure 95,  systoHc.  Examination  of  the  urine  shows  slight  trace  of 
albumen  and  suga^-;  otherwise,  negative;  examination  of  the  blood 
shows  hemoglobin  68  per  cent. 

This  patient  was  placed  on  extract  of  the  thyroid  gland,  0.5  grain 
three  times  daily,  increased  to  14  grains  a  day;  Fowler's  solution 
4  minims,  and  tincture  digitalis  10  minims  three  times  a  day.  Under 
this  treatment  there  was  a  gradual  improvement  and  patient  was 
discharged  after  six  weeks.  At  time  of  discharge  her  blood  pressure 
was  108.  The  change  in  this  patient  was  so  marked  that  her  hus- 
band and  friends  had  difficulty  in  recognizing  her. 

CASE   2 

T.  L.,  age  52,  brother  of  Case  1. 

Entered  the  hospital  on  October  8,  complaining  of  headache, 
stiffness  of  the  legs,  loss  of  memory,  vertigo,  always  cold,  never  per- 
spu-ing  and  chronic  constipation. 

Family  history.     Same  as  that  in  Case  No.  1. 

Past  history.  Negative,  except  an  injury  twenty-seven  years  ago, 
which  was  followed  by  Bell's  paralysis. 

Present  illness.  Fifteen  years  ago  began  to  grow  stiff,  which  in- 
creased to  such  an  extent  that  at  the  present  time  he  has  great 
difficulty  in  walking.  Ten  years  ago  first  noticed  puffiness  of  the 
eyehds;  at  that  time  the  skin  was  rough,  dry,  scaly,  the  complexion 
became  sallow,  hair  began  to  fall  out  in  the  axillary  spaces  and  he 
complained  of  being  more  or  less  constantly  cold. 

Physical  examination.     Well  developed  man;  skin  over  the  entire 


138  E.    F.    RAPHEL 

body  cold,  dry  and  scaly.  The  nails  are  brittle,  the  hair  dry  and 
sparse ;  scalp  thick,  covered  with  fine  white  scales ;  the  eyelids  puffed ; 
the  lips  and  tongue  thick;  the  voice  hoarse;  the  abdomen  distended; 
the  eyes  react  to  light  and  accommodation;  there  is  a  bilateral 
deafness  which  is  more  pronounced  on  the  left  side;  paralysis  left 
side  of  face;  memory  is  very  poor;  examination  of  the  lungs  is  nega- 
tive; temperatui'e  95;  pulse  50;  respiration  20;  blood  pressure  124; 
hemoglobin  57;  examination  urine,  negative. 

Treatment.  This  patient  was  under  treatment  for  several  weeks; 
he  was  given  dry  thyroid  gland  in  0.5  grain  doses,  which  was  in- 
creased until  2  grains  were  taken  three  times  a  day;  Fowler's  solu- 
tion 4  minims  and  tincture  digitalis  10  minims  three  times  a  day. 
Under  this  treatment  blood  pressure  dropped  from  124  to  105;  he 
was  then  given  pituitrin  10  minims  three  times  day;  this  was  in- 
creased to  15  minims  and  later  given  hj-podermically.  During  the 
administration  of  the  pituitrin  the  blood  pressure  gradually  dropped 
until  it  reached  85 ;  pituitrin  was  discontinued  and  the  blood  pressure 
gradually  increased  until  it  reached  105,  when  he  was  discharged 
from  the  hospital.  During  treatment  of  this  patient,  it  was  noticed 
that  his  skin  became  soft  and  oily,  his  complexion  clear;  there  was 
a  marked  improvement  in  the  hearing  and  vision;  complete  recovery 
from  vertigo;  the  hair  on  the  head  became  very  much  thicker  and 
weakness  disappeared. 

,  In  both  these  patients,  I  noticed  that  they  would  complain  of  a 
burning  and  tingling  sensation  in  the  fingers  and  toes,  extending 
gradually  upward  to  their  hands,  accompanied  by  a  feeling  of  nausea, 
which  was  most  marked  upon  arising  in  the  morning,  during  the 
time  that  they  were  taking  the  maximum  quantity  of  the  thyroid 
medication.  These  symptoms  would  disappear  when  the  thyroid 
was  discontinued  for  a  few  days,  but  would  recur  if  large  doses  were 
resumed. 

Both  of  these  patients  returned  to  their  homes  very  much  im- 
proved and  very  giateful. 

The  following  is  an  extract  from  a  letter  written  by  K.  M.  very 
recently : 

"Doctor:  I  am  feehng  fine.  I  can  do  my  work  with  ease.  I 
don't  need  but  very  little  of  the  medicine  now.  I  can't  tell  you 
how  grateful  I  am  for  my  good  health." 


REPORT   OF   LIBRARIA.]Sr  139 

ABSTRACT  OF  THE  REPORT  OF  RUTH  LEE  BRISCOE, 

LIBRARIAN  OF  THE  UNIVERSITY  OF  MARYLAND 

MEDICAL  SCHOOL 

Library  of  the  University  of  Maryland, 

23rd  September,  1916. 

To  the  Library  Committee  of  the  University  of  Maryland, 

Gentlemen:  I  beg  to  submit  herewith  a  partial  account  of  the 
activities  of  the  Library  of  the  University  of  Maryland: 

The  year  1915-1916  was,  in  some  respects  the  best  year  that  the 
Library  has  known;  the  routine  work  progressed  more  smoothly,  we 
had  a  greater  number  of  accessions,  more  adequate  heating  facilities, 
and  improved  janitor  service.  There  was  a  noticeable  increase  in 
the  attendance  in  all  departments,  especially  those  of  dentistry  and 
pharmacy,  the  rate  of  which  had  previously  been  low.  From  a  few 
"stragglers  in"  we  are  able  to  report  from  ten  to  twenty-five  stu- 
dents at  many  times  during  the  library  day  (10  a.m.  to  10.30  p.m.) 
with  a  minimum  daily  attendance  of  one  hundred  and  twenty-five 
(all  departments).  The  circulation  of  books  was  also  larger.  This 
would  seem  to  indicate  a  healthy  growth,  a  greater  appreciation  of 
the  advantages  of  the  Library,  and  a  more  hearty  cooperation  on 
the  part  of  the  student-body. 

In  January,  1916,  a  number  of  text-books,  journals,  etc.,  which 
had  been  the  property  of  the  Baltimore  Medical  College,  and  had 
not  been  added  to  the  Library  of  the  University  of  Maryland,  were 
brought  from  the  basement  of  the  Library  and  investigated.  Fifty- 
five  volumes  were  added  to  the  Library  from  this  source. 

In  July,  1916,  we  received  a  large  collection  of  books,  journals, 
etc.,  constituting  a  part  of  the  library  of  the  College  of  Physicians 
and  Surgeons.  This,  also,  was  sorted  and  as  a  result  four  hundred 
and  six  volumes  were  added  to  the  Library  of  the  University  of 
Maryland.  They  include  text-books,  journals,  proceedings,  trans- 
actions, pamphlets,  and  interesting  works  in  general  literature;  rep- 
resenting entire  works  and  editions  of  text-books,  and  bound  vol- 
umes of  journals  which  we  wanted. 

Our  files  of  journals  are  incomplete  in  some  instances,  and  when  it 
is  recalled  that  the  ''journals  are  the  back-bone  of  the  medical  li- 
brary" the  value  of  such  accessions  is  appreciated.  Some  wanted 
numbers  of  various  "Transactions,"  which  came  in  the  latter  col- 
lection, were  also  added. 


140 


CORRESPONDENCE 


Accessions  from  other  sources  during  1915-1916,  77  volumes. 
Total  accessions  (Medical  Department,)  538  volumes. 


LIST   OF   DONORS 


Sir  William  Osier,  Bart. 

Provost  Thomas  Fell 

Prof.  Randolph  Winslow 

Prof.  J.  M.  H.  Rowland 

Prof.  W.  Simon 

Prof.  Jos.  T.  Smith 

Prof.  J.  Holmes  Smith 

Prof.  W.  S.  Gardner 

Prof.  R.  Dorsey  Coale's  Estate 

Prof.  B.  Merrill  Hopkinson 

Dr.  Nathan  Winslow 

Dr.  A.  V.  Aviles 

Dr.  Elmer  Newcomer 

Dr.  A.  Jacobi 

Dr.  A.  J.  Underhill 

Dr.  R.  H.  Fergusson 

Dr.  Jos.  E.  Beatty 


Dr.  Howard  Fox 

Miss  Merle  Bateman 

Mrs.  Ruth  Lee  Briscoe 

Messrs.  Lea  and  Febiger 

Messrs.  W.  B.  Saunders  and  Co. 

Mr.  Hudson  Maxim 

Mr.  W.  L.  Mallalieu 

Mr.  A.  Dorsey  Johnson 

New  York  University 

Bureau  of  Laboratories,  City  of  New 
York 

British  War  Office 

Bureau  of  the  Census 

Carnegie  Endowment  for  Interna- 
tional Peace 

Maryland  Medical  Journal 


Dr.  Henry  M.  Thomas  presented  an  engraving  of  the  late  Dr.  E. 
L.  Trudeau  which  he  had  framed,  together  with  an  autograph  let- 
ter from  Sir  William  Osier. 

Our  file  of  eighty  cm-rent  medical  journals  embraces  most  of  the 
important  American  publications,  including  the  Index  Medicus, 
and  some  of  the  foreign  journals. 

A  mmiber  of  students  have  been  instructed  in  the  methods  of  do- 
ing reference  work  in  medical  books  and  journals,  the  correct  form 
of  arrangement  of  citations  in  their  bibUographies; — also  how  to  bor- 
row books  from  the  Library  of  the  Surgeon-General  in  Washington. 

The  Y.  M.  C.  A.  assisted  us  materially  by  supplying  current  Ht- 
erature  and  a  file  of  daily  papers.  The  reading-room  was  used  by 
them  on  a  nimiber  of  Sunday  afternoons,  for  rehgious  talks,  etc. 

CORRESPONDENCE 

The  Presbyterian  Hospital, 
San  Juan,  Porto  Rico, 

December  19,  1916. 
Prof.  Randolph  Winslow,  Baltimore,  Md. 

.  My  Dear  Professor  Winslow:  For  a  long  time  I  have  been  planning  to 
write  you  and  now  in  these  holidays  1  could  not  find  a  better  opportunity.  1 
will  start  by  wishing  you  and  all  my  teachers  the  best  Christmas  time  and  all 
kind  of  prosperity  in  the  New  Year. 


CORRESPONDENCE  141 

A  few  weeks  after  getting  down  here,  1  entered  as  an  interne  to  the  Presby- 
terian Hospital  where  1  am  getting  a  good  deal  of  experience.  This  hospital 
contains  60  beds  and  all  the  time  it  is  full  of  a  great  variety  of  cases,  especially 
surgical.  There  are  two  more  internes  besides  me  and  a  resident  physician. 
Most  of  the  work  1  have  done  has  been  in  surgery,  and  1  am  very  satisfied  of 
the  good  preparation  1  received  in  the  old  University  of  Maryland.  Up  to 
this  time  1  have  done  about  thirty  operations  myself.  Among  them  I  have 
had  apendectomies,  herniotomies,  and  amputations — and  so  far  with  good 
results. 

All  the  other  fellows  which  came  down  this  year  are  in  practice  and  are  do- 
ing pretty  well.  Quevedo  is  going  to  be  a  rich  man  pretty  soon.  He  has  his 
practice  at  Avasco  and  is  getting  more  money  than  any  other  of  us. 

1  have  received  the  monthly  publication  of  the  conjoined  schools  and  1 
think  it  is  very  interesting  and  valuable  especially  for  us  who  are  so  far  away 
from  our  Alma  Mater  and  which  endeavor  to  have  all  the  news  concerning  her. 

Please  give  my  regards  to  all  my  other  teachers,  and  1  am 

Yours  sincerely, 

H.  F.  Carrasouillo. 

Detroit,  Mich., 

December  11,  1916. 
Dr.  Nathan  Winslow: 

Friend  Nathan:  1  have  just  received  a  copy  of  the  Bulletin  and  in  it  1 
see  an  article  on  some  "antiseptic  dressing"  for  wounds,  the  formula  of  which 
has  a  very  large  percentage  of  "Methyl  Alcohol,"  he  calls  it  denatured  alco- 
hol. 1  am  writing  this  in  the  hopes  that  you  will  do  all  in  your  power  to 
prevent  use  of  wood  alcohol  in  dressings  or  for  any  use  on  the  body.  If  any- 
thing seems  proved  to  be  fraught  with  danger  to  sight  and  of  an  unremedial 
type,  it  is  wood  alcohol.  1  do  not  doubt  but  that  Woods,  Friedenwald,  Harlan 
and  the  others  have  already  written  you.    This  is  really  very  serious  business. 

Yours  with  kindest  regards, 

Ed.  J.  Bernstein. 

New  Kensington,  Pa. 
December  29,  1916. 

Dr.  J.  M.  H.  Rowland,  Dean,   University  of  Maryland  School  of  Medicine, 

Baltimore,  Md. 
My  dear  Doctor  Rowland: 

Some  two  years  ago  I  received  the  enclosed  card  and  letter  from  my  former 
professor  on  diseases  of  women  in  B.  M.  C.  (1893)  Prof.  Ashby.  At  that  time, 
I  did  not  take  advantage  of  the  kind  offer,  but  noticing  in  the  November 
issue  of  the  Bulletin  that  Alumni  of  B.  M.  C.  could  secure  this  certificate, 
I  enclose  check  for  ten  dollars  and  will  consider  it  a  favor  if  you  will  send 
me  the  certificate  at  your  earliest  convenience. 

I  do  not  know  whether  you  remember  me  or  not,  but  we  boarded  at  the 
same  boarding  house,  I  think  in  the  after  part  of  the  term  of  1891-92. 

After  graduating  I  came  directly  to  Pittsburgh  on  my  way  home,  and  took 
the  examination  at  West  Penn  Medical  College  for  endorsement  of  my  diploma 


142  CORRESPONDENCE 

to  enable  me  to  practice  in  Pennsylvania.  I  passed  the  examination  success- 
fully, and  located  at  New  Kensington,  Westmoreland  County.  I  have  per- 
sistently engaged  in  the  practice  from  that  date  to  this  and  have  succeeded 
past  my  expectations.  I  am  engaged  in  general  practice;  the  only  forced 
vacation  I  have  had  to  take  in  that  time,  was  from  May  15,  1894  to  July  25, 
1894  to  pass  through  a  siege  of  typhoid  fever. 

I  have  a  family  of  wife  and  six  children,  one  boy,  a  junior  at  Washington 
and  Jefferson  College,  Washington,  Pa.,  five  girls,  the  oldest  attending  school 
at  Oberlin  College,  Ohio;  youngest  six  years  of  age  the  8th  of  this  month, 
so  you  see,  I  have  something  to  keep  me  busy. 

At  present,  I  am  a  member  of  Allegheny  County  Medical  Society,  it  being 
more  convenient  to  attend  there  than  at  Greenburg,  county  seat  of  West- 
moreland County,  in  Avhich  I  am  located;  am  a  member  of  the  Board  of 
Education  in  New  Kensington,  have  served  as  president  and  treasurer  of  the 
Board.  Served  as  treasurer  in  1913  when  we  built  a  high  school  building 
costing  upwards  of  $300,000. 

We  have  about  20,000  people  in  our  vicinity  and  about  28  or  30  physicians 
have  a  local  organization  for  business  purposes  in  particular,  have  been  con- 
stantly connected  with  it  since  its  organization  some  fifteen  or  eighteen  years 
ago.  We  have  a  good  fraternal  feeling  in  our  community  because  of  it,  get  a 
greater  percentage  of  our  earnings  and  I  believe  the  people  get  better  services. 

You  will  pardon  me  for  giving  the  history  here  recorded,  but  as  you  were  a 
former  B.  M.  C.  member,  and  I  had  a  slight  acquaintance  with  you,  I  thought 
in  view  of  the  position  you  now  occupy  that  it  might  be  of  some  interest  to 
know  something  of  the  history  of  a  B.  M.  C.  graduate  of  1893. 

I  wish  you  abundant  success  in  your  office  as  Dean  of  The  School  of  Medicine 
of  University  of  Maryland.  Very  respectfullj'  yours, 

A.  S.  Kaufman. 

St.  Louis,  Mo. 
January  8,  1917. 
Dr.  Nathan  Winslow,  Edilor  Hospital  Bulletin  of  the  University  of  Maryland, 

Baltimore,  Md. 
Dear  Doctor: 

On  December  15,  1916,  1  severed  my  connection  with  the  Interstate  Medical 
Journal  as  literary  editor,  and  after  the  December  number  my  labors  on  that 
journal  ceased  altogether. 

In  February,  1917,  1  shall  start  a  journal  of  my  own  which  will  be  known 
as  Medicine  and  Surgery,  and  will  have  all  the  literary  qualities  which  made 
the  Interstate,  during  my  editorship,  covering  some  six  years,  one  of  the 
outstanding  publications. 

In  making  this  announcement  to  you,  1  am  prompted  by  the  thought  that 
this  news-item  will  be  of  interest  to  you,  and  that  you  will  avail  yourself  of 
the  opportunity  of  making  mention  of  it  in  your  esteemed  publication. 

Sincerely  yours. 
Room  608  Metropolitan  Building  Phii-ip  Skrainka. 

St.  Louis,  Mo. 


BULLETIN 

OF    THE 

UNIVERSITY   OF    MARYLAND  SCHOOL   OF   MEDICINL 

AND 

College  of  Physicians  and  Surgeons 


Publication  Commiltee 

Randolph   Winslow,  A.M.,  M.D.,  LL.D.  Wm.  S.  Gardner,  M.D. 

J.  M.  H.  Rowland,  M.D. 

Nathan  Winslow,  A.M.,  M.D.,  Editor 

Aascciate  Editors 

Albert  H.  Carroll,  M.D.  Andrew  C.  Gillis,  A.M.,  M.D. 

John  Evans,  M.D. 


Happy  New  Year! 

Christmas  is  past  and  we  hope  that  all  our  alumni  and  readers 
have  enjoyed  the  pleasures  and  blessings  of  a  joyous  yuletide.  At 
this  writing  we  are  on  the  threshold  of  a  new  year  and  who  can  say 
what  shall  befall  us,  individually  and  collectively,  in  the  year  to 
come.  The  times  are  parlous  and  are  fraught  with  dangerous  pos- 
sibilities, yea,  even  probabilities;  "for  we  know  that  the  whole  crea- 
tion groaneth  and  travaileth  in  pain  together  until  now."  While 
this  country  has  not  been  in  the  throes  of  actual  warfare  and  has  in 
many  respects  enjoyed  great  prosperity,  nevertheless,  we  have  tra- 
vailed in  pain  with  those  who  have  suffered,  and  have  ourselves  been 
the  subject  of  such  indignities  and  atrocities,  that  a  new  year  which 
dawns  in  peace  may  close  in  disaster."  "With  malice  towards  none 
and  with  charity  for  all"  we  pray  that  not  only  we,  but  the  nations 
that  are  now  engaged  in  mortal  strife,  may  have  peace.  May  this  be 
the  dawn,  not  only,  of  a  happy  new  year  but  of  a  new  era,  in  which 
might  shall  not  be  synonymous  with  right,  and  in  which  justice  shall 
be  the  guiding  light  in  the  relations  of  one  nation  with  another. 

In  a  more  restricted  sense  we  desire  to  extend  to  our  alumni,  stu- 
dents and  friends  everywhere  our  best  wishes  for  a  Happy  New 
Year. 

143 


144  editorials 

Medical  Preparedness 

The  question  of  the  unpreparedness  of  this  country  to  defend  itself 
against  even  a  second  class  power  is  being  forced  upon  the  attention 
of  the  citizens  and  authorities  of  the  nation  alike.  Until  the  present 
colossal  and  barbaric  conflict  broke  out  it  was  fatuously  thought,  or 
at  least  hoped,  that  wars  were  a  thing  of  the  past,  incompatible 
with  civilization  and  with  Christianity. 

It  was  also  believed  by  many  in  this  country  that  we  were  in  no 
danger  of  attack  by  any  power  that  could  injure  us;  that  our  brave 
and  patriotic  sons  would  spring  to  arms  over  night  and  hm*l  back 
into  the  sea  any  foreign  foe  that  might  have  the  temerity  to  land 
upon  our  shores.  "Battleships,"  in  the  language  of  the  inland  Con- 
gressman, "would  be  built  in  every  creek"  and  woe  betide  the  ad- 
versary who  should  incur  our  righteous  wrath. 

Treaties  were  supposed  to  be  solemn  and  uTefrangible  covenants 
that  were  to  be  observed  to  the  letter;  by  means  of  which  the  weak 
were  protected  and  the  strong  restrained.  The  oceans  that  lave  our 
shores  were  thought  to  be  our  greatest  protection  and  to  render  it 
almost  unpossible  for  a  foreign  power  to  invade  our  land  in  sufficient 
force  to  overcome  our  citizen  soldiery.  Our  eyes  have  been  opened. 
The  ocean  is  a  ready  highway,  treaties  are  "scraps  of  paper,"  battle- 
ships cannot  be  built  in  creeks  and  armies  cannot  be  raised  over- 
night. The  country  is  in  great  danger  and  is  entirely  unprepared 
to  meet  it.  Not  only  are  we  unprepared  to  meet  force  with  force 
but  we  are  unprepared  in  every  other  way. 

From  a  medical  standpoint  we  are  especially  unprepared.  Even  on 
a  peace  basis  the  medical  corps  of  the  army  is  insufficient  and,  even 
now,  during  this  Mexican  fiasco,  it  has  been  necessary  to  call  upon 
the  Medical  Reserve  Corps  for  assistance.  For  six  months  the  Edi- 
tor of  the  Bulletin  has  been  in  active  service  with  General  Persh- 
ing in  Mexico,  at  a  great  sacrifice  of  his  private  and  professional  in- 
terests. 

With  the  strictly  mifitary  aspects  of  the  situation  we  are  interested 
only  as  are  other  citizens,  but  with  the  medical  aspects  we  are  vitally 
concerned  as,  in  the  event  of  war,  the  profession  in  general  must 
answer  the  call.  Is  an5i;hing  being  done  in  the  way  of  preparing  for 
possible  emergencies?  We  may  say  that  a  great  deal  is  being  done. 
A  strong  committee  of  prominent  physicians  and  surgeons,  with 
Dr.  WilHam  J.  Mayo  at  its  head,  is  actively  engaged  in  putting  the 
country  in  a  state  of  medical  preparedness  by  organizing  hospital 


EDITORIALS  145 

units,  by  collecting  medical  and  sui-gical  supplies  and  by  enlisting 
medical  men  for  service  when  required. 

But  more  than  this  is  needed  in  order  to  meet  the  emergency  suc- 
cessfully and  the  Committee  of  Defence  has  now  called  upon  the 
medical  schools  to  measure  up  to  the  occasion  as  a  patriotic  duty. 
At  the  recent  session  of  the  Southern  Sm-gical  Association,  held  at 
White  Sulphur  Springs,  West  Virginia,  Dr.  Frankhn  H.  Martin  of 
Chicago  practically  demanded  that  the  Medical  Colleges,  beginning 
on  February  1,  1917,  make  provision  for  two  hours  instruction  a  week 
in  military  medicine,  under  army  instructors,  to  the  classes  that  will 
graduate  in  June  next;  and  that  thereafter  a  carefully  arranged  cm'- 
riculum  in  military  medicine  be  adopted.  It  will  be  very  difficult 
to  comply  with  this  demand  this  session.  We  beheve  it  ought  to 
be  done  and  we  think  it  must  be  done.  The  need  of  medical  pre- 
paredness we  beheve  to  be  as  urgent  as  that  of  military  adequacy. 
So  urgent  does  the  Government  regard  the  situation  that  the  Sec- 
retary of  War,  Hon.  Newton  D.  Baker,  requested  representatives  of 
the  various  medical  schools  to  attend  a  conference  in  Washington  on 
January  6,  1917  in  order  to  formulate  plans  to  meet  the  emergency. 
Profs.  James  M.  H.  Rowland,  Dean  and  Randolph  Winslow,  Presi- 
dent of  the  Faculty  of  Physic,  accepted  the  invitation  to  attend 
this  meeting  as  the  representatives  of  the  University  of  Maryland. 

The  Library  of  the  University  of  Maryland 

We  invite  our  friends  to  visit  our  library,  and  we  mean  especially 
the  medical  library.  We  shall  be  glad  to  have  any  respectable  mem- 
ber of  the  medical  profession,  whether  he  is  a  graduate  of  the  Uni- 
versity or  not,  make  use  of  our  books  and  jom'nals.  We  have  a 
large  collection  of  books  and  of  journals  that  are  available  for  ref- 
erence. Mrs.  Ruth  Lee  Briscoe,  the  Ubrarian,  will  welcome  any 
visitor  and  will  render  such  assistance  as  may  be  desii'ed.  We  are 
not  an  affluent  institution  and  the  bulk  of  our  books  are  obtained  by 
donation  and  not  by  purchase.  Anyone  who  has  more  books  than 
he  has  room  for,  or  who  wishes  to  dispose  of  his  hbrary,  is  invited 
to  donate  them  to  the  University  of  Maryland.  Amongst  every 
such  lot  of  books  there  are  some  that  we  desire  to  fill  out  sets  or  to 
replace  others  that  are  worn  out,  though  of  course  there  are  many 
that  are  duphcates.  We  can  make  use  of  all  such  donations  and 
will  separate  the  chaff  from  the  wheat  ourselves. 


146  editorials 

With  the  Regulars  in  Mexico 

Dr.  Nathan  Winslow,  who  is  now  serving  with  the  Punitive 
Expedition  in  Mexico,  writes  interestingly  of  his  experiences  as 
an  army  surgeon.  In  a  letter  dated  September  8,  he  says,  "I  have 
been  assigned  to  medical  work  aad  put  in  charge  of  the  malarial 
ward.  It  is  nothing  unusual  to  have  this  tent  filled  to  its  capacity, 
which  is  24  beds.  Besides  malaria  I  have  had  to  look  out  for  the 
surplus  amebic  dysentery  cases,  as  well  as  doing  laboratory  work. 
I  have  done  my  level  best  to  give  good  service  and  if  I  have  fallen 
short  it  has  been  through  no  lack  of  effort  on  my  part.  I  am  at 
work  by  seven  in  the  morning  and  never  quit  before  the  same  hour 
at  night,  making  a  rather  long  day,  and  then  it  is  all  too  short  to 
accomplish  all  that  I  should." 

He  writes  a  few  days  later  that  the  constant  and  unaccustomed 
use  of  "the  microscope  is  playing  havoc  with  my  eyes,  so  much  so 
that  yesterday  I  was  obliged  to  lay  off." 

"I  have  several  patients  in  my  ward  giving  me  a  good  deal  of 
concern.  One  is  a  case  of  malaria  complicated  with  amebic  dysen- 
tery, whose  fever  every  other  day  goes  up  to  106.  The  other  case 
has  been  running  a  continuous  evening  temperature  from  102  to 
104,  for  which  I  can  find  no  cause. 

"In  the  ward  of  the  officer  whom  I  assist  there  is  a  case  of  what 
might  be  abscess  of  the  liver.  We  think  it  to  be  amebic  dysentery 
but  have  been  unable  to  find  amebae  in  the  stools. 

"The  sm-gical  ward  lost  a  case  of  gas  infection  following  amputa- 
tion for  compound  fracture  due  to  the  kick  of  a  horse.  However, 
considering  the  number  of  men  here,  the  wildness  of  the  country, 
and  the  lack  of  modern  sanitation  the  amount  of  sickness  has  been 
very  small. 

"I  have  under  my  care  31  men  whom  I  suspect  of  having  para- 
typhoid fever.  Not  having  had  any  experience  with  this  disease 
I  was  unable  to  explain  their  condition.  One  man  had  had  typhoid 
vaccination  and  I  could  not  believe  he  had  typhoid  fever  so  I  made 
a  blood  culture  and  sent  it  to  Fort  Bliss  and  received  a  telegram 
that  the  culture  was  one  of  paratyphoid.  I  suppose  the  other 
cases  are  similar.  My  ward  is  now  given  over  to  fevers  of  unde- 
termined'or  unproved  type  and  it  is  up  to  me  to  definitely  find  out 
the  nature  of  the  trouble.  Last  week  I  was  swamped  with  malaria, 
this  week  with  this  pecuhar  affection. 


EDITORIALS  147 

"The  men  are  taken  suddenly  with  severe  headache,  situated 
mostly  over  the  eyes,  slight  dry  cough,  chilliness  and  high  fever, 
103  to  106°,  congested  face  and  marked  prostration.  It  was  thought 
the  diseases  might  be  typhus  but,  as  no  lice  were  found  in  their 
clothes,  that  disease  seemed  improbable. 

"Though  my  experience  is  not  what  I  would  choose,  being  medi- 
cal instead  of  sm-gical,  still  I  have  seen  a  large  number  of  cases  of 
amebic  dysentery,  malaria  and  what  seems  to  be  paratyphoid  fever, 
and  the  experience  will  not  be  in  vain,  especially  as  I  have  had  a 
great  deal  of  microscopical  work  to  do.  There  is  absolutely  no 
news  and  we  are  pretty  much  in  the  dark  concerning  the  doings  of 
the  outside  world,  but  one  learns  to  get  along  without  it,  especially 
if  you  have  something  to  keep  you  busy." 

In  a  recent  letter  Lieutenant  Winslow  says,  "Until  the  past  few 
days  I  have  been  hard  at  work  and  have  hardly  had  time  to  breathe; 
in  fact,  to  do  anything  but  work.  There  has  been  an  epidemic  of 
paratyphoid  fever  here.  About  the  time  the  disease  set  in  most 
of  the  officers  of  Field  Hospital  No.  3  had  been  relieved  for  one 
reason  or  another,  leaving  only  three  of  us  here.  The  major  com- 
manding took  charge  of  the  surgical  work,  while  the  captain  and 
I  divided  the  medical  work  between  us.  At  one  time  we  had  charge 
of  over  250  patients;  a  few  typhoid,  malaria,  amebic  dysentery 
and  venereal  cases,  but  most  of  them  cases  of  paratyphoid  fever. 
At  the  height  of  the  trouble  there  were  6  wards,  of  32  beds  each, 
devoted  to  paratyphoid  fever  alone.  The  first  cases  which  came 
in  had  us  up  in  the  air;  the  chnical  picture  was  entirely  different 
from  any  I  had  ever  seen  and,  indeed,  none  of  us  had  seen  the  like. 
We  were  undecided  whether  it  was  dengue,  typhus  or  paratyphoid, 
so  we  were  considerably  relieved  when  the  laboratory  report  reached 
us  that  it  was  paratyphoid.  It  was  then  up  to  us  to  find  out  the 
cause  but  in  this  we  have  been  unsuccessful.  As  there  are  millions 
of  flies  here  it  is  probable  that  they  spread  the  disease.  The  next 
problem  was  to  obtain  a  prophylactic  serum,  if  possible.  When 
it  arrived  its  administration  was  more  or  less  an  experiment.  You 
can  imagine  our  pleasure  when  we  found  a  marked  reduction  in 
the  admission  rate  even  after  the  first  administration  of  the  serum. 
After  the  second,  the  disease  almost  entirely  ceased,  and  after  the 
third  dose  the  epidemic  became  a  thing  of  the  past.  Both  the 
captain  and  I  thoroughly  expected  to  be  taken  down  with  the  mal- 
ady but  have  escaped. 


h 


148  EDITORIALS 

"Altfiough  this  experience  will  be  of  little  use  to  me  in  private 
practice,  still,  I  deem  it  a  privilege  to  have  been  permitted  to  serve 
my  fellowmen  in  such  an  unexpected  and  novel  emergency." 

While  Dr.  Winslow  escaped  paratyphoid  fever  he  did  not  go 
scott-free  from  all  ailments.  In  one  letter  he  says,  "I  am  just 
getting  well  of  a  carbuncle  of  the  back.  It  had  to  be  cut  three 
times  before  it  gave  any  evidence  of  being  in  hand.  I  had  no  idea 
they  were  so  painful  and  made  you  feel  so  miserable.  It  was  all 
I  could  do  to  get  about  but  there  were  so  many  sick  to  look  after 
that  I  could  not  lay  down  on  the  job,  though  I  did  stay  in  my  ward 
in  the  hospital  one  night,  in  order  to  have  hot  dressings  appHed. 
This  experience  gave  me  an  insight  into  a  fever  ward  that  I  could 
not  have  gotten  otherwise.  Thu'ty-one  men  were  raving  maniacs 
all  night;  one  wanted  water,  another  something  else,  and  some 
did  not  know  what  they  wanted." 

"A  Soldier  or  Sailor  no  Better  Than  His  Teeth" 

Dr.  Grady's  Preparedness  Idea  is  set  forth  at  the  Forsythe  Dental 

Infirmary,  Boston 

Writing  in  "Frocks  and  Frills,"  for  the  Baltimore  Sun  in  a  recent 
edition  of  that  paper,  Miss  Emily  E.  Lantz,  Editor  of  "Frocks  and 
Frills"  has  the  following  of  local  interest: 

"a  soldier  or  sailor  no  better  than  his  teeth" 

While  meditating  upon  the  things  Baltimore  needs  for  1917,  a  news  para- 
graph catches  the  eye.  It  is  in  effect  that  Boston,  Mass.,  on  January  20, 
1917,  members  of  the  dental  profession  will  present  a  silver  loving  cup  to  Mr. 
Thomas  A.  Forsythe,  who  has  given  to  the  city  in  the  Forsythe  Dental  In- 
firmary for  Children  the  first  institution  of  its  kind  in  the  world.  It  is  an 
infirmary  where  the  teeth  of  children  are  examined  and  treated  free  of  charge 
and  where  the  public  is  taught  the  close  relation  between  sound  teeth  and 
health  and  instructed  how  to  take  care  of  the  former.  Oliver  Wendell  Holmes 
has  said:  "The  dental  profession  has  established  and  prolonged  the  reign  of 
beauty;  it  has  added  to  the  charms  of  social  intercourse  and  lent  perfection 
to  the  accents  of  eloquence;  it  has  taken  from  old  age  its  most  unwelcome 
feature,  and  lengthened  enjoyable  human  life  far  beyond  the  limit  of  years 
when  the  toothless  and  purblind  patriarch  might  well  exclaim,  '1  have  no 
pleasure  in  them.'  " 


EDITORIALS  149 

In  this  great  training  school  for  physical  national  preparedness 
Maryland  has  a  part  because  the  subject  of  oral  hygiene  in  relation 
to  school  children  was  fii'st  introduced  in  1900  by  Dr.  Richard 
Grady,  formerly  of  Baltimore,  and  now  dental  surgeon  of  the  United 
States  Naval  Academy  at  AnnapoHs.  Dr.  Grady  was  also  the 
organizer  and  for  many  years  the  director  of  the  Baltimore  Poly- 
technic Institute,  the  first  school  devoted  to  manual  training  in 
America.  Among  his  dental  associates  he  is  Imown  as  the  "father 
of  the  national  mouth  hygiene  movement"  and  quite  fittingly  he 
deHvered  at  the  Forsythe  Infinnary  on  December  10,  the  first  of 
the  course  of  free  lectures  to  be  given  by  eminent  men  upon  sub- 
jects relating  to  public  health. 

Dr.  Grady's  preparedness  idea  is  that  no  soldier  nor  sailor  is 
better  than  his  teeth.  His  dental  creed  is  "Good  teeth,  good  health, 
with  the  logical  explanation : 

Without  good  teeth,  there  cannot  be  thorough  mastication. 

Without  thorough  mastication,  there  cannot  be  perfect  digestion. 

Without  perfect  digestion,  there  cannot  be  proper  assimilation. 

Without  proper  assimilation,  there  cannot  be  nutrition. 

Without  nutrition,  there  cannot  be  health. 

Without  health,  what  is  life? 

Hence  the  paramount  importance  of  the  teeth. 

It  is  infinitely  more  vital  to  teach  children  this  creed  than  the 
free-verse  rendering  of  the  immortal  tale  concerning  the  "House 
that  Jack  Built." 

The  public  is  thoroughly  alive  to  its  duty  toward  the  child  in 
developing  its  mind,  yet  of  equal  importance  is  the  development 
of  its  body.  The  child  with  neglected  teeth  suffers  inferioi-  physical 
development.  Baltimore  requires  no  systematic  examination  of 
the  teeth  of  children  admitted  to  the  public  schools  other  than  that 
incident  to  the  physical  examination  made  by  health  officers,  and 
there  are  free  dental  clinics  to  which  attendance  is  voluntary. 

It  really  does  seem  as  though  some  Maryland  magnate  might 
establish,  during  1917,  an  infirmary  for  oral  hygiene  in  Baltimore. 

The  committee  in  charge  of  the  presentation  of  the  Forsythe 
Loving  Cup  and  Banquet  have  selected  Dr.  Grady  to  represent 
the  State  of  Maryland  as  a  member  of  the  honorary  committee  as 
it  will  appear  on  the  menu  at  Hotel  Somerset,  Boston. 


150  marriages 

Final  Financial  Statement    of  the  Journal  of  the  College 
OF  Physicians  and  Surgeons  Alumni  Association 

Balance  1914-1915 $72.58 

Collected  at  Banquet 204.00 

Paid  by  advertisers 596 .  50 

Subscriptions  paid. . * 219. 00 

$1092.08 

Banquet  expenses. $200.75 

Returned  advance  subscriptions 19.00 

Postage 216 .  54 

Printing,  etc 461 .  63 

$1087.92 
Balance 4.16 

The  delay  in  rendering  this  report  was  due  to  the  retarded  col- 
lection of  advertising  account. 

All  claims  against  the  Journal  have  been  satisfied. 


BIRTHS 

Born— on  November  30,  1916,  to  Dr.  and  Mrs.  T.  Marshall  West 
of  Fayetteville,  N.  C,  a  daughter,  Frances  Lanney  West. 

MARRIAGES 

Dr.  Robert  Parke  Bay,  chief  surgeon  of  the  Maryland  National 
Guard  and  one  of  the  best-known  younger  surgeons  of  the  city,  was 
married  to  Miss  Nancy  M.  McNabb,  of  Harford  County,  on  Satur- 
day, December  23,  1916.  The  Rev.  Dr.  George  C.  Peck  performed 
the  ceremony  in  the  parsonage  of  First  Methodist  Episcopal 
Church. 

Dr.  Bay  is  also  from  Harford  County,  but  did  not  meet  his  bride 
until  he  was  a  medical  student  at  the  University  of  Maryland  and 
Miss  McNabb  was  a  novitiate  nurse.  Both  are  32  years  old.  He 
graduated  in  1905  and  became  resident  surgeon  of  the  University 
Hospital  for  two  years,  for  one  year  medical  superintendent  of  Bay- 
view  Hospital  and  superintendent  of  the  University  Hospital  in 


ITEMS  151 

1909  and  1910.  He  has  been  chief  surgeon  of  the  Maryland  Bri- 
gade, with  rank  as  major,  since  1911,  and  in  1914  was  named  chief 
medical  examiner  for  the  State  Industrial  Accident  Commission. 
He  is  a  fellow  of  the  American  College  of  Surgeons.  He  was  not 
called  upon  to  accompany  the  Maryland  troops  to  the  border  and 
recently  asked  to  resign  his  commission,  but  was  refused. 

A  romance  of  medical  school  and  hospital  was  culminated  in  the 
marriage  of  Miss  Eva  Saunders,  1403  West  Fayette  Street,  and  Dr.  C. 
Chapin  Childs,  of  Niagara  Falls,  N.  Y.,  by  the  Hev.  Dr.  Henry  M. 
Wharton  at  his  home,  1307  Linden  Avenue. 

Dr.  Childs  is  a  graduate  of  the  University  of  Maryland  Medical 
School,  and,  before  taking  up  his  practice  in  Niagara  Falls,  was  an 
interne  in  hospitals  here.  His  bride  was  for  some  time  superintend- 
ent of  the  operating  room  at  Franklin  Square  Hospital  and  later  be- 
came superintendent  of  the  hospital  of  the  Poole  Engineering  and 
Machine  Company  at  Woodberry. 

ITEMS 

It  is  learned  that  Major  Robert  P.  Bay,  chief  surgeon  of  the  First 
Brigade,  Maryland  National  Guard,  sent  his  resignation  to  Brig.- 
Gen.  Charles  D.  Gaither,  who  declined  to  accept  it.  Major  Bay  said 
he  wished  to  leave  the  service  because  his  surgical  practice  was  such 
that  he  could  not  devote  to  the  military  the  time  required  of  a  chief 
surgeon  under  the  new  system. 

He  went  to  Laurel  with  the  troops  in  June  and  remained  on  duty 
until  the  last  unit  left  for  Eagle  Pass,  and  would  have  gone  to  the 
border  had  he  been  called  upon  for  duty  there.  Major  Bay  has  been 
connected  with  the  guard  for  a  number  of  years. 

Dr.  John  D.  Blake,  Commissioner  of  Health,  has  been  ill  at  his 
home,  1014  West  Lafayette  avenue.  It  was  stated  that  he  was  suf- 
fering from  overwork  Dr.  Blake  has  been  at  his  desk  early  and 
late  for  several  months,  the  recent  outbreak  of  infantile  paralysis 
demanding  practically  all  of  his  time. 

The  family  is  not  alarmed  over  his  condition  and  expects  him  to 
be  out  in  a  few  days. 


152  ITEMS 

Major  J.  Harry  Ullrich,  of  Field  Hospital  No.  1,  who  almost  lost 
his  eye  when  struck  by  a  flying  crank  handle  while  starting  his  auto- 
mobile has  improved.  His  phj^sician,  Dr.  Herbert  C.  Blake,  said  he 
will  be  forced  to  remain  several  da3^s  at  his  home,  12  North  Carey 
Street,  because  of  the  discoloration  of  the  eye.  His  cheek  bone  is 
also  depressed.  Major  Ullrich  had  retm-ned  home  from  Eagle  Pass, 
Texas,  on  a  furlough.  The  accident  happened  in  front  of  the  home 
of  his  father-in-law.  Commissioner  James  Rittenhouse,  of  Balti- 
more County,  near  Mount  Winans. 

The  will  of  Dr.  HoUiday  Hicks  Hay  den,  probated  in  the  Orphans' 
Court  gives  his  medical  library  to  the  College  of  Physicians  and 
Surgeons. 

Mayor  Preston  will  hold  an  audience  within  a  day  or  two  with 
representatives  of  the  Hospital  Conference  Association  of  Maryland 
to  discuss  the  advisabiUty  of  supplying  the  public  hospitals  of  the 
city  with  free  water  and  removal  of  ashes.  Dr.  H.  J.  Moss,  presi- 
dent of  the  association  and  superintendent  of  the  Hebrew  Hospital, 
and  H.  H.  Warfield,  manager  of  the  University  Hospital,  in  a  letter 
addressed  to  the  Mayor  yesterday  requested  that  they  be  granted 
an  interview  so  that  they  might  explain  the  burdens  that  are  being 
carried  by  the  institutions  and  the  injustice  of  taxing  them  for  the 
use  of  water  in  free  wards  and  the  disposal  of  ashes. 

Dr.  Henry  R.  Carter,  Sr.,  University  of  Maryland  1879,  assistant 
surgeon  general  of  the  United  States  PubUc  Health  Service  and  a 
widely  known  expert  on  yellow  fevef,  who  returned  from  his  second 
trip  with  members  of  the  International  Health  Commission  to  South 
America  and  resumed  his  duties  as  superintendent  of  the  Marine 
Hospital,  on  Remington  Avenue,  stated  today  that  he  has  not  made 
up  his  mind  whether  he  will  accompany  the  members  of  the  expedi- 
tion on  their  proposed  third  trip  to  Mexico,  Brazil  and  South  Africa. 

Said  Dr.  Carter:  "So  far  our  expedition  has  been  successful.  On 
our  first  trip  we  visited  places  along  the  lower  eastern  and  western 
coasts  of  South  America,  and  on  our  second  expedition  we  visited 
Ecuador,  Peru,  Columbia  and  Venezuela.     We  found  that  in  most 


ITEMS  153 

cases  that  the  reports  of  the  great  havoc  wrought  by  the  disease 
were  exaggerated  and  that  comparatively  Uttle  of  the  disease  exists 
at  the  present  time.  If  the  campaign  succeeds,  the  yellow  fever 
parasite  will  be  as  extinct  as  the  Dodo,  and  as  incapable  of  being 
resm'rected." 

On  December  29,  while  responding  to  an  urgent  call  to  come  to  a 
patient  who  was  believed  suddenly  to  have  become  mentally  unbal- 
anced. Dr.  George  H.  Hocking,  of  Govans,  was  shot  three  times  by 
the  patient  as  he  started  to  ascend  the  stairs  to  the  man's  room. 

Besides  firing  the  three  shots  into  Dr.  Hocking — two  bullets  pene- 
trated the  left  shoulder  and  one  the  fleshy  part  of  the  left  arm,  all 
three  emerging — Gantz  fired  at  the  physician  a  fourth  shot,  which 
went  wild. 

Though  Dr.  Hocking  was  suffering  from  the  shock  to  which  he 
had  been  subjected,  as  well  as  from  loss  of  blood,  he  was  able  to 
walk  to  his  home,  about  half  a  mile  distant.  There  he  was  treated 
by  Dr.  John  Preston  Peters  and  Dr.  M.  Gibson  Porter.  The  shots 
having  gone  clear  through  the  wounded  members,  the  danger  of 
compHcations  was  eliminated  to  a  large  extent. 

Dr.  and  Mrs.  J.  Frederick  Hempel,  3310  West  North  Avenue,  have 
issued  invitations  for  the  marriage  of  their  daughter  Adelaide,  to 
Dr.  John  H.  Traband,  U.  of  M.  1912,  on  Wednesday,  January  10. 
The  ceremony  will  be  performed  at  St.  Mark's  English  Lutheran 
Church,  St.  Paul  and  Twentieth  Streets. 

Dr.  Ernest  Zueblin,  professor  of  experimental  and  clinical  medi- 
cine at  the  University  of  Maryland,  left  recently  for  Cincin- 
nati, where  he  will  become  director  of  the  Branch  Tuberculosis 
Hospital  and  a  member  of  the  faculty  of  the  University  of  Cincin- 
nati. While  here  Dr.  Zueblin  Hved  at  the  Latrobe,  Charles  and 
Read  streets. 

Dr.  Frederick  W.  Fochtman,  one  of  the  leading  physicians  of 
Cumberland,  was  found  dead  in  his  automobile  at  Ellerslie,  five 
miles  north  of  Cumberland,  recently.  He  had  spent  the  afternoon 
in  calling  on  patients  there. 


154  ITEMS 

Boys  noticed  that  Dr.  Fochtman's  automobile  was  standing  still 
and  that  he  was  reclining  peculiarly.  Investigation  showed  him 
to  be  dead  with  his  foot  clamped  on  the  brake,  which  he  evidently 
applied  as  he  died. 

The  body  was  brought  to  his  home  on  Bedford  Street,  after 
an  inquiry  by  Coroner  Joseph  B,  Finan. 

Dr.  Fochtman  had  not  been  in  the  best  of  health,  although  he  had 
improved  following  an  operation  at  Rochester,  Minn.,  in  1910.  A 
few  weeks  ago  he  accidentally  broke  a  rib. 

Dr.  Fochtman  was  a  graduate  at  the  College  of  Physicians  and 
Surgeons  at  Baltimore,  class  of  1889.  Previously  he  had  read 
medicine  under  Dr.  J.  Jones  Wilson,  this  city.  He  was  one  of  the 
pioneer  X-ray  operators  of  this  section,  having  a  complete  equip- 
ment, and  held  membership  in  the  American  Medical  Association 
and  the  Allegany  County  Medical  Society. 

Dr.  Fochtman  was  about  50  3^ears  old. 

The  inventory  of  the  personal  estate  of  the  late  Dr.  Louis  McLane 
Tiffany,  filed  in  the  Orphans'  Court,  shows  a  total  valuation  of 
$673,573.31,  nearly  all  of  which  is  represented  in  stocks  and  bonds. 

Dr.  Tiffany's  investments  extended  to  many  parts  of  this  and 
foreign  countries.  Among  his  foreign  investments  are  Republic  of 
Argentine  internal  public  debt,  5  per  cent,  1929,  $15,354.33;  Anglo- 
French  loan,  5  per  cent,  1920,  $7,590;  city  of  Paris  municipal  ex- 
terior, 6  per  cent  1920,  $2955;  Spanish-American  Iron,  first  mortgage 
sinking  fund  bonds,  6  per  cent,  $1025;  Imperial  Japanese  Govern- 
ment, 4|  per  cent,  1925,  $8,571.20. 

The.  furniture  at  Dr.  Tiffany's  late  home,  831  Park  Avenue,  is 
appraised  at  $759.  He  had  in  bank  $10,444.84  and  he  owned  a 
yacht  valued  at  $400. 

The  Safe  Deposit  and  Trust  Company  is  executor  of  the  estate, 
of  which  Mrs.  Tiffany  receives  one-half  absolutely  and  one-half  in 
trust  for  life,  to  go  after  her  death  to  his  daughter's  children. 

John  F.  Hogan,  M.D.,  C.  P.  &  S.,  '11,  who  was  assistant  resident 
surgeon  in  Mercy  Hospital  for  two  years,  and  who  since  that  time 
has  been  superintendent  of  Sydenham  Hospital  for  Contagious  Dis- 
eases, has  been  recently  appointed  Assistant  Health  Commissioner 


ITEMS  155 


of  Baltimore  City.     Dr.  Hogan  will  have  direct  charge  of  all  com- 
municable diseases  as  well  as  the  work  of  the  health  wardens. 


H.  H.  Johnson,  M.D.,  C.  P.  &  S.,  '15,  resident  physician  at  Mercy 
Hospital  during  the  year  1916,  and  assistant  on  the  staff  of  Syden- 
ham Hospital,  has  been  appointed  superintendent  to  succeed  Dr. 
Hogan. 

J.  D.  Dinsmore,  M.D.,  C.  P.  &  S.,  '09,  is  serving  with  the  Ca- 
nadian Army  in  England  as  a  member  of  the  Medical  Reserve  Corps 
with  the  rank  of  captain.  Dr.  Dinsmore  is  now  stationed  at  Bran- 
shatt,  England  attached  to  stationary  hospital  No.  9. 

Percy  P.  Hartt,  M.D.,  C.  P.  &  S.,  '13,  resident  gynecologist  in 
Mercy  Hospital  during  the  years  1914  and  1915,  is  serving  with 
Canadian  forces  in  England  on  the  Medical  Reserve  Corps.  Dr. 
Hartt  has  the  rank  of  captain. 

Aubrey  F.  Lawson,  M.D.,  C.  P.  &  S.,  '11,  assistant  resident  phy- 
sician on  the  Mercy  Hospital  staff  during  the  year  1912,  and  who 
since  that  time  has  been  practicing  in  Coalton,  W.  Va.,  has  recently 
been  appointed  assistant  resident  surgeon  on  Dr.  Harrison's  staff  in 
Mercy  Hospital. 

D.  M.  Aikman,  M.D.,  C.  P.  &  S.,  '16,  assistant  resident  surgeon 
on  the  Mercy  Hospital  staff  since  June,  has  recently  resigned  to  en- 
ter private  practice. 

L.  H.  Howard,  M.D.,  C.  P.  &  S.,  '16,  assistant  resident  surgeon, 
on  duty  in  the  accident  department  of  Mercy  Hospital,  has  also 
resigned. 

W.  A.  Boyd,  M.D.,  assistant  in  neurology  and  psychiatry  1914- 
1916,  is  now  stationed  at  Honolulu,  Hawaii,  as  first  lieutenant  in 
the  Medical  Reserve  Corps  of  the  United  States  Army. 


156  DEATHS 

Dr.  C.  W.  Roberts,  formerly  of  the  Douglas  Hospital,  Douglas, 
Ga.,  begs  to  announce  the  removal  of  his  offices  to  rooms  827-828 
Candler  Building,  Atlanta,  Ga.  Practice  limited  to  siu-gery  and 
gynecology. 

DEATHS 

Dr.  Holliday  Hicks  Hay  den  died  at  his  home,  1425  Light  Street. 
He  was  stricken  with  heart  failure. 

He  was  a  native  of  Queen  Anne's  County,  where  he  was  born  47 
years  ago.  He  was  graduated  from  the  College  of  Physicians  and 
Surgeons  and  at  one  time  was  on  the  staff  of  the  Bayview  Hospital. 
He  was  a  member  of  the  Masonic  fraternity  and  also  of  the  Univer- 
sity Club. 

Dr.  Alexander  H.  Saxton,  who  died  Sunday,  December  24.  1916,  at 
his  home,  432  North  Carey  Street,  was  one  of  the  best  representa- 
tives of  the  older  body  of  physicians  whose  life  and  active  medical 
practice  spanned  the  years  from  the  Civil  War  to  the  present  time. 

Born  in  Baltimore  in  1839,  Dr.  Saxton  attended  the  public  schools 
and  later  entered  Georgetown  College,  Washington.  He  completed 
his  college  course,  but  the  class  was  dismissed  and  the  college  closed 
on  account  of  the  war,  and  it  was  not  until  a  number  of  years  later 
that  degrees  were  awarded  to  the  graduated  students. 

Leaving  Georgetown,  Dr.  Saxton  entered  the  School  of  Medicine 
of  the  University  of  Maryland,  from  which  he  was  graduated  on 
March  7,  1863,  receiving  his  diploma  from  a  faculty  that  included 
such  well-known  men  as  Dr.  Nathan  R.  Smith,  Dr.  Samuel  Chew, 
Dr.  George  W.  Miltenberger,  Dr.  Richard  McSherry,  Dr.  William 
E.  A.  Aiken  and  others. 

Growing  up  in  the  traditions  of  the  older  medical  school.  Dr. 
Saxton  represented  the  highest  ideals  of  the  general  practitioner. 
Though  his  special  interests  inevitably  led  him  to  concentrate  on 
certain  kinds  of  work,  his  experience  and  sympathy  were  so  wide 
that  he  was  never  content  to  devote  himself  exclusively  to  any  one 
branch  of  medicine  or  surgery  Intellectually  of  fine  appreciation 
and  wide  reading,  both  in  medical  and  general  literatm'e,  he  retained 
to  the  end  a  very  alert  interest  in  books,  in  politics  and  especially  in 
the  growth  and  development  of  his  native  city,  in  which  he  had  lived 
to  see  a  very  wonderful  transformation. 


DEATHS  157 

Dr.  Howard  C.  Reamer,  50  years  old,  a  San  Francisco  physician, 
was  found  dead  in  his  room  at  the  Hotel  Hermann,  Eutaw  and 
Pratt  Streets,  with  a  bullet  hole  in  his  temple. 

He  had  been  dead  about  12  hours,  the  length  of  time  he  had  been 
missing  from  the  home  of  his  brother,  James  Reamer,  2644  North 
Charles  Street,  who  had  notified  the  police  of  his  disappearance. 

He  was  undressed  and  lying  in  front  of  his  bureau,  with  a 
38-calibre  pistol  beside  him.  He  had  evidently  guided  his  hand  by 
watching  himself  in  the  mirror .  On  the  bureau  were  two  notes,  one 
addressed  to  the  hotel  proprietor  and  the  other  to  a  brother.  The 
note  to  the  hotel  proprietor  read : 

"Due  to  ill-health  a  long  time.  Am  sorry  to  cause  the  proprietor 
any  trouble.  It  is  awful  to  have  to  wait  until  late,  so  I  will  not 
alarm  the  house.  Please  notify  W.  M.  Reamer,  2000  East  Biddle 
Street." 

Dr.  Reamer  was  a  graduate  of  the  University  of  Maryland  Class 
of  1885. 

Dr.  J.  Tyler  Smith,  a  well-known  physician  of  West  Baltimore, 
died  suddenly  from  apoplexy,  at  his  home,  717  North  CarroUton  Ave- 
nue. Dr.  Smith  was  born  in  Gore,  Frederick  County,  Va.,  Novem- 
ber 17,  1844,  and  was  a  member  of  one  of  the  oldest  families  in  the 
state.  He  was  educated  at  the  University  of  Virginia,  graduating 
in  1876,  and  from  the  University  of  Maryland  the  next  year.  For 
the  last  35  years  he  has  practiced  in  this  city,  and  was  twice  ap- 
pointed Assistant  Health  Commissioner. 

William  Pawson  Chunn,  Jr.,  21  years  old,  son  of  Dr.  William  P. 
Chunn,  1023  Madison  Avenue,  died  suddenly  at  Saranac  Lake, 
N.  Y.  Word  of  the  young  man's  death  was  contained  in  a  tele- 
gram received  by  Dr.  Samuel  K.  Merrick,  824  Park  Avenue.  He 
and  S.  Seymour  Merrick,  Dr.  Merrick's  son,  whose  tragic  death 
occurred  a  few  weeks  ago,  had  been  chums  since  boyhood. 

A  native  of  Baltimore,  Mr.  Chunn  attended  private  preparatory 
schools  and  was  a  star  football  player  at  Johns  Hopkins  University. 
He  was  attending  the  University  of  Maryland  Law  School  at  the 
time  he  was  taken  ill. 


158  BOOK   REVIEWS 

BOOK  REVIEWS 

The  Basis  of  Symptoms.  The  Principles  of  Clinical  Pathology.  By 
LuDOLPH  Krehl,  Ordinary  Professor  and  Director  of  the  Medi- 
cal Clinic  in  Heidelberg.  Authorized  translation  from  the 
seventh  German  edition,  by  Arthur  Frederic  Beifeld, 
Ph.B.,  M.D,,  Instructor  in  Medicine,  Northwestern  Univer- 
sity Medical  School,  Chicago.  With  an  introduction  by  A. 
W.  Hewlett,  M.D.,  Professor  of  Internal  Medicine,  Univer- 
sity of  Michigan,  Ann  Arbor.  Third  American  Edition. 
Philadelphia  and  London:  J.  B.  Lippincott  Company.  1916. 
Cloth,  S5.00  net. 

Until  quite  recently  diseases  was  gauged  according  to  the  damage 
inflicted  to  the  anatomical  structures  of  the  body,  and  symptoms 
resulting  were  fixed  to  fit  these  changes.  This  feature  of  medicine 
has  attained  an  accuracy  almost  magical,  until  it  is  now  not  un- 
common in  the  mortuary  to  find  the  lesions  as  indicated  by  the 
signs  and  predicted  by  the  diagnostician.  Unfortunately  in  most 
instances  when  changes  have  taken  place  in  the  bodily  structures, 
no  therapy  is  of  avail  in  a  restoration  to  the  original  condition  pre- 
vailing in  health.  So  now  for  some  little  time  clinicians  and  their 
laboratory  collaborators  have  been  devoting  their  attention  to  per- 
version of  the  physiological  processes,  hoping  thereby  to  prevent 
changes  in  the  anatomical  structures  composing  the  body  by  ar- 
resting the  process  before  any  organic  changes  have  occm'red.  An 
immense  amount  of  labor  has  been  devoted  to  this  phase  of  medi- 
cine, resulting  in  the  accumulation  of  a  mass  of  profitable  knowledge 
in  the  recognition  and  treatment  of  disease.  Professor  Krehl 
has  done  an  immense  amount  of  original  as  well  as  confirmatory 
work  in  this  field  of  medicine  which  observations  he  has  incorpor- 
ated in  a  book  under  the  title  of  Pathologische  Physiologic.  In  order 
to  make  it  available  for  English  readers  Doctor  Beifeld  has  trans- 
lated the  seventh  German  edition  into  the  English  language.  This 
edition  mirrors  the  growth  of  pathological  pltysiology  and  includes 
the  results  of  the  most  recent  observations  of  a  host  of  workers, 
devoting  much  space  to  the  cardiac  arrhj'thmias,  leukemias,  pseudo- 
leukemias, anaphylaxis,  complement  fixation,  the  phenomena  of 
gastric  secretion  and  motility,  the  renal  functional  tests,  the  glands 
of  internal  seci'etion,  gout,  etc.     In  addition,    there  has  been  in- 


BOOK   REVIEWS  159 

eluded  a  new  chapter  on  "Constitutional  Diseases  and  Diatheses." 
No  more  important  work  has  appeared  during  the  past  few  years. 
Physicians  working  along  these  Hues  should  find  it  a  distinct  stimu- 
lus in  their  endeavors  of  solving  many  obscure  functional  derange- 
ments of  the  body.  Every  progressive  physician  should  not  only 
read  it  but  thoroughly  digest  the  contents.  It  gives  us  great 
pleasure  to  recommend  it  to  our  readers. 

The  Art  of  Anesthesia.  By  Paluel  J.  Flagg,  M.D.,  Lecturer  In 
Anesthesia,  Fordham  University  Medical  School;  Anesthetist 
to  Roosevelt  Hospital;  Instructor  in  Anesthesia  to  Bellevue 
and  Allied  Hospitals,  Fordham  Division;  Consulting  Anesthet- 
ist to  St.  Joseph's  Hospital,  Yonkers,  N.  Y.;  formerly  anes- 
thetist to  the  Woman's  Hospital,  New  York  City.  136  Illus- 
trations. Philadelphia  and  London:  J.  B.  Lippincott  Com- 
pany.    1916.     Cloth,  $3.50  net. 

A  properly  given  anesthetic  is  as  essential  to  a  successful  opera- 
tive issue  as  a  perfect  operative  technic.  This  fact  has  been  to  a 
large  extent  overlooked,  but  operators  are  now  beginning  to  realize 
that  the  best  anesthetist  is  none  too  good  for  their  cases.  This  is 
as  it  should  be.  There  is  a  great  deal  of  difference  in  anesthetiz- 
ing a  patient  and  doing  it  scientifically.  The  practical  aspects  of 
•administering  a  good  anesthetic  cannot  be  gotten  froin  text-books 
but  from  actual  experience,  still  a  good  book  will  help  the  novice 
over  many  difficult  places  and  enable  him  to  better  understand  the 
art.  Those  who  are  going  to  engage  in  an  operative  procedure  with 
which  they  are  unacquainted  labor  diligently  to  equip  themselves 
for  the  task  either  by  reading  the  experience  of  others  or  practising 
on  the  cadaver.  This  does  not  apply  to  the  anesthetist,  he  as  a 
rule  without  any  too  much  previous  knowledge  or  experience  is  en- 
trusted with  the  administering  of  anesthetics  to  patients  suffering 
with  the  most  serious  surgical  conditions.  Therefore  a  better 
theoretical  knowledge  of  the  different  anesthetics  will  mean  better 
anesthesia  and  more  recoveries,  which  is  the  arm  of  surgical  art. 
The  art  of  anesthesia  can  only  be  acquired  by  the  anesthetist 
familiarizing  himself  with  the  laws  which  govern  its  administration 
and  by  developing  the  ability  to  properly  correlate  and  apply  these 
laws.  The  student,  novice  and  general  practitioner  will  find  this 
book  an  excellent  guide  in  acquiring  the  elements  of  the  art  of  anes- 


160  BOOK    REVIEWS 

thesia.  It  briefly  considers  the  history  of  anesthesia,  then  launches 
into  a  comprehensive  discussion  in  turn  of  general  anesthesia,  local 
anesthesia  and  mixed  anesthesia.  A  detailed  consideration  of  the 
induction,  maintenance,  and  signs  of  anesthesia  takes  up  three 
chapters.  The  technic  of  administering  ether,  chloroform,  nitrous 
oxide,  nitrous  oxide  oxygen,  nitrous  oxide  oxygen  ether  and  ethyl 
chloride  consumes  about  six  chapters.  The  book  presents  the  sub- 
ject in  a  very  pleasing  and  simple  style,  and  should  prove  of  ines- 
timable value  in  rounding  off  the  rough  edges  of  those  engaged  in 
administering  anesthetics. 


JOHN  WESLEY  CHAMBERS 


BULLETIN 

OF  THE 

University  of  Maryland  School 
OF  Medicine 

AND 

College  of  Physicians  and 
Surgeons 

Successor  to  The  Hospital  Bulletin,  of  the  University  of  Maryland, 
Baltimore  Medical  College  News,  and  the  Journal  of  the  Alumni  Abso- 
ciation  of  the  College  of  Physicians  and  Surgeons 

Vol.  I  FEBRUARY,  1917  No.  7 


JOHN  WESLEY  CHAMBERS 

Professor  of  Surgery 
Died,  January  21,  1917 


By  Harry  Friedenwald 

Before  me  there  rises  the  picture  of  the  Faculty  of  the  College  of 
Physicians  and  Surgeons  in  the  eighties,  a  body  of  strong  and  able 
men,  whom  we  loved  in  our  student  days,  whom  we  revered  more 
and  more  as  we  grew  older  and  assumed  positions  of  responsibility 
and  trust  which  they  had  built  up  and  bequeathed  to  our  generation. 
The  youngest  of  these  men  was  John  Wesley  Chambers,  at  that 
time,  demonstrator  of  anatomy.  He  was  still  in  the  twenties.  His 
days  were  spent  in  large  part  in  earnest  work  in  the  dissecting  room. 
He  was  as  intimate  with  the  students  as  they  were  with  one  another, 
and  they  looked  upon  him  as  the  embodiment  of  all  that  was  known 
of  anatomy.  The  accuracy  of  his  knowledge  made  them  stand  in 
amazement.  It  seemed  to  us  that  there  was  no  detail  too  small  or 
insignificant  to  interest  him,  none  to  escape,  that  nothing  that  he 
had  seen  was  ever  forgotten.  In  all  his  work  there  was  the  leaven 
of  wit  and  humor.     Earnest  and  intense,  he  was  ever  ready  with 

161 


162  HARRY    FRIEDENWALD 

good  story  or  a  brilliant  epigram  to  emphasize  the  point  he  was 
trying  to  convey.  His  kindness  and  sympathy  for  the  students  made 
him  the  friend  of  everyone  of  us.  His  influence  on  the  students 
was  profound,  due  as  much  to  his  infectious  enthusiasm  for  work 
and  study  as  to  immediate  instruction.  He  taught  anatomy  for 
fifteen  years,  first  as  prosector,  then  as  demonstrator  and  from 
1889  to  1894  as  professor. 

His  studies  in  anatomy  were  soon  applied  to  surgery.  In  the 
early  eighties  he  had  a  surgical  service  at  Bay  View  and  his  opera- 
tions about  the  neck  and  elsewhere  were  like  the  most  careful  and 
accurate  dissections.  There  was  nothing  too  difficult  for  the  in- 
trepid young  surgeon.  He  was  fearless  becaiise  he  was  sure  of  his 
ground  and  of  Ms  own  skill.  In  those  days  the  new  teachings  of 
antisepsis  began  timidly  to  come  to  Baltimore.  He  had  observed 
Erich,  operating  under  the  carbolic  spray,  with  bad  results.  He 
had  read  of  the  use  of  antiseptic  solutions  and  the  disinfection  of 
instruments  and  he  was  the  first  in  the  then  City  Hospital  to  apply 
these  new  methods  in  general  surgery;  his  early  work  was  very- 
crude  but  it  was  effective  and  made  a  good  beginning. 

He  had  studied  surgery  in  the  dissecting  room.  During  his 
student  days,  during  all  his  early  years  he  never  had  the  opportunity 
to  witness  the  work  of  any  eminent  surgeon  outside  of  Baltimore. 
I  remember  how  gratified  he  was  in  1885  to  see  Agnew  of  Philadel- 
phia, operate  in  Baltimore  for  the  removal  of  a  large  tumor  from 
the  leg.  And  yet  he  knew  of  every  operative  procedure,  he  had 
applied  it  or  had  tried  it  on  the  cadaver  and  he  read  surgical  litera- 
ture omnivorously.  I  have  already  referred  to  his  unfailing  memory. 
His  operative  skill,  his  deftness  of  hand  and  the  marvellous  rapidity 
of  his  movements  were  the  reasons  that  all  his  friends  looked  upon 
him  as  a  "born  surgeon." 

It  might  thus  appear  that  Dr.  Chambers's  interest  was  limited 
to  surgery.  Nothing  would  be  fiurther  from  the  truth.  The  Latin 
proverb  with  change  of  a  word  may  well  be  applied  to  him:  "Nihil 
medicinae  milii  alienmn  est."  His  knowledge  of  clinical  medicine, 
his  wide  experience  and  his  diagnostic  acumen  made  him  the  equal 
of  most  of  his  medical  colleagues,  in  their  special  fields.  It  was 
this  extraordinary  combination  of  knowledge  and  experience  in 
medicine  and  surgery  that  gave  him  the  rare  ability  to  detect  and 
discover  disease  with  what  appeared  to  be  intuition.     In  the  ward 


JOHN    WESLEY    CHAMBERS  163 

the  medical  men  had  the  same  respect  for  him  as  did  the  surgeons, 
for  his  insight  and  judgment.  In  1894  Dr.  Chambers  became 
professor  of  operative  and  chnical  surgery  and  in  1898  of  surgery. 
As  a  teacher  he  was  not  systematic.  He  abhorred  system  as  he 
did  any  restraint.  His  teaching  of  surgery  was  therefore  most  ef- 
fective at  the  bedside  in  making  diagnoses  and  discussing  treatment, 
and  in  the  operating  room  in  demonstrating  the  method  of  operation 

I  have  said  that  he  was  no  lover  of  system.  His  early  education 
had  been  that  of  a  country  school  and  academy.  He  entered  upon 
the  study  of  medicine  without  any  training  in  the  sciences  and  in 
medicine  he  was  truly  autodidact.  What  he  accomplished  was  done 
by  reason  of  liis  great  talents.  What  he  would  have  done  had  he 
been  given  thorough  modern  preparatory  training,  it  is  impossible  to 
state.  Of  this  I  am  sure,  that  he  would  have  had  few  equals  in  this 
country. 

But  Dr.  Chambers  was  more  than  a  physician  and  a  surgeon, 
more  than  a  teacher  of  anatomy  and  a  teacher  of  surgery.  He  was 
a  man  who  in  any  field  of  activity  would  have  stood  forth  because 
of  his  remarkable  qualities  of  mind  and  of  heart.  He  had  wide 
interests  and  clear  judgment.  He  gathered  a  great  store  of  general 
knowledge  by  extensive  reading  and  by  his  tenacious  memory.  He 
was  interested  in  every  field  of  hiunan  activity  and  thought.  The 
welfare  of  the  city,  state  and  of  the  country  were  dear  to  him.  No 
public  question  arose  which  did  not  engage  his  attention  and  upon 
which  he  did  not  form  well  defined  opinions.  His  intense  interest 
in  politics  is  thus  understood.  He  had  clear  views  on  the  most 
varied  subjects  and  having  formed  opinions  he  stood  his  ground 
tenaciously.  And  yet  as  has  elsewhere  been  said:  "He  was  as  tol- 
erant of  the  views  of  others  as  he  was  strong  and  fearless  in  his  own 
opinions."  On  more  than  one  occasion  have  we  heard  him  say: 
"I  am  ready  to  compromise  on  policies  but  I  cannot  compromise  on 
principles."  He  was  strong  and  courageous,  as  he  was  kind  and 
generous  and  tender.  His  friends  loved  him  not  because  of  his 
skill  in  surgery  or  of  his  knowledge  of  medicine,  but  because  he  was 
loyal  and  warm  hearted  ready  at  all  times  to  serve.  He  was  a  man 
full  of  sympathy,  filled  with  the  milk  of  human  kindness.  No  one 
in  the  profession  of  this  state  had  more  friends,  few  had  such  a  wide 
range  in  the  profession  and  in  every  walk  of  life. 


164  J.    CARROLL   MONMONIER 

At  a  special  meeting  of  the  Facility  of  Physic,  University  ot 
Maryland  School  of  Medicine  and  College  of  Physicians  and  Sur- 
geons, held  at  midday,  January  23,  the  following  sentiments  regard- 
ing the  late  Dr.  John  W.  Chambers,  professor  of  surgery,  were  order- 
ed spread  upon  the  minutes: 

We  have  learned  with  deep  sorrow  of  the  death  of  Prof.  John  Wesley 
Chambers.  He  was  associated  with  our  School  since  his  student  days. 
After  graduating  at  the  College  of  Physicians  and  Surgeons  in  1878,  he  be- 
came resident  physician  of  the  City  Hospital,  prosector,  demonstrator  and 
professor  of  anatomy,  professor  of  operative  and  clinical  surgery,  and,  finally, 
professor  of  surgery,  which  chair  he  held  at  the  moment  of  his  death.  This 
association,  extending  over  forty  years,  was  one  of  intense  interest,  of  deep 
affection,  and  of  loyal  devotion. 

Dr.  Chambers  was  a  man  of  exceptional  endowments.  A  rare  combina- 
tion of  the  surgeon  and  the  physician,  he  showed  keen  powers  of  medical 
diagnosis  and  was  able,  with  never-failing  resourcefulness,  to  apply  his  great 
surgical  skill. 

As  a  man  he  was  characterized  by  clear  and  almost  intuitive  judgment,  by 
wide  interests,  by  broad  sympathies,  by  warm-hearted  and  generous  treat- 
ment of  all  with  whom  he  came  in  contact — his  patients,  his  acquaintances, 
his  colleagues  and  his  friends.  He  was  as  tolerant  of  the  views  of  others 
as  he  was  strong  and  fearless  in  his  own  opinions. 

We  have  lost  in  his  death  a  friend  whom  we  loved  and  admired,  a  col- 
league upon  whose  judgment  we  relied  and  in  whose  loyal  support  we  could 
always  trust.     We  shall  ever  cherish  his  memory. 

To  his  bereaved  widow  and  children  we  extend  our  sincere  sympathy  and 
condolence. 

J.  M.  H.  Rowland, 

January  23,  1917.  Dean. 

PRESIDENTIAL  ADDRESS^ 

By  Dr.  J.  Carroll  Monmonier 

Catonsville 

Mr.  Chairman,  Fellows  of  the  Baltimore  County  Medical  Association, 
Gentlemen: 

The  honor  and  pleasure  of  having  been  president  of  this  Associa- 
tion for  the  year  now  closed,  shall  ever  be  to  me  a  cherished  memory; 
and,  it  is  with  deep  appreciation  that  I  heartily  repeat  my  thanks 
to  you.  The  excellent  support  of  our  efficient  secretary,  and  the 
courtesy  and  cooperation  of  the  members  is  gratefully  acknowledged. 

^  Delivered  on  January  17,  1917. 


PRESIDENTIAL   ADDRESS  165 

For  my  subject  I  have  selected  "The  County  Man  of  Today," 
and  my  remarks  are  intended  to  refer  especially  to  the  Baltimore 
County  man. 

While  it  is  my  behef  that  modern  ways  and  modern  methods 
have  been  generally  adopted  by  men  in  practice  in  Baltimore  County 
today,  and  along  the  line  of  advancement  it  has  become  apparent 
from  increase  in  membership,  that  these  men  recognize  the  advan- 
tages of  affihation  with  that  primary  unit  of  the  National  Organ- 
ization— the  County  Medical  Association;  membership, . however 
serves  only  as  a  mark  of  identification.  It  is  to  the  regular  attend- 
ant that  the  advantages  accrue. 

At  this  point  it  might  be  well  to  refer  to  the  unique  and  exceptional 
advantages  enjoyed  and  offered  by  the  Baltimore  Coimty  Medical 
Association  of  which  we  are  all  justly  proud. 

This  Association  has  evolved  into  a  large  and  harmonious  organi- 
zation. Usually  one  or  more  scientific  papers  have  been  read  and 
discussed  at  its  monthly  meetings.  The  Baltimore  County  man 
has,  at  Httle  inconvenience,  on  account  of  proximity  and  easy  acces- 
sibility, enjoyed  advantages  extended  through  the  courtesy  and 
generosity  of  executives  of  hospitals  and  institutions.  In  this  he 
has  the  cooperation,  courtesy  and  generosity  of  leading  men  of  ac- 
tive and  associate  membersliip  of  this  Association,  connected  with 
these  hospitals  and  institutions  of  national  and  international  re- 
nown, in  and  around  Baltimore.  Furthermore  with  a  great  medi- 
cal hbrary  at  our  door,  in  what  other  county  of  the  state,  perhaps 
of  the  entire  country,  do  conditions  so  favorable  to  the  county  man 
prevail.  The  program  committee  of  this  Association,  with  pro- 
gressive spirit  stimulated  by  the  successive  line  of  advanced  instruc- 
tion brought  about  by  carefully  prepared  cMnics,  scientific  papers 
and  discussions  chiefly  through  the  efforts  of  comparatively  few 
members,  recognizing  that  it  was  the  duty  of  the  Association  as  a 
body,  to  provide  for  the  continuation  of  some  of  these  good  things, 
in  the  name  of  the  Association,  took  upon  itself  recently  the  responsi- 
bility of  engaging  a  film  corporation  to  show  (for  the  first  time  in 
Maryland)  war  films  depicting  exceptional  injuries  and  conditions, 
and  the  advances  in  medicine  and  surgery  that  have  developed  to 
meet  them,  in  the  great  European  war. 

In  further  recognition  of  the  value  of  this  continuous  post-gradu- 
ate course,  so  to  speak,  to  the  county  man,  it  seems  just  and  proper 
for  the  Association  to  make  some  provision,  such  as  by  assessment, 


166  J.    CARROLL   MONMONIER 

or  increase  in  the  amount  of  dues,  to  enable  the  program  committee 
to  arrange  for  meetings  and  clinics  at  institutions,  without  the  em- 
barrassment of  having  to  seek  entertainment  at  luncheon,  which 
precedent  has  established  a  necessary  adjunct  to  the  meetings. 

To  the  county  man,  the  laboratory  of  the  State  Board  of  Health 
offers  exceptional  facilities  for  examination  of  specimens;  is  prompt 
in  making  reports  of  its  findings.  In  the  opinion  of  the  writer, 
this  aid  in  making  proper  diagnoses  should  be  more  extensively 
utiHzed.^ 

The  requirements  of  the  department  of  communicable  diseases, 
also  of  the  department  of  vital  statistics,  as  to  the  reporting  of 
cases  have  increased  the  labors  of  the  physician.  I  believe  their 
demands  should  be  met  in  the  proper  spirit  and  complied  with 
wilhngly  for  the  good  of  the  community. 

In  the  suburban  sections,  physicians  may  be  aided  in  their  work 
by  securing  the  services  of  the  so  called  hourly  nurse.  In  matters 
of  pubhc  health,  the  county  men  have  been  interested  and  active. 
In  many  instances  their  admonitions  have  not  been  heeded  and 
their  earnest  efforts  unappreciated.  This  lack  of  cooperation  on 
the  part  of  the  public,  can  no  longer  be  attributed  to  ignorance, 
but  must  be  set  down  as  a  result  of  a  narrow  selfishness  which  fails 
to  appreciate  the  value  of  the  general  health  of  the  commimity  to 
each  individual. 

Modern  commercial  methods  in  the  keeping  of  records  of  cases 
and  accounts  can  be  found  in  the  office  of  the  county  man,  and  his 
professional  work  is  facilitated  and  systematized  thereby.  The 
workmen's  compensation  law  as  now  effective  in  this  state  has  not 
lessened  his  labors,  and  he  is  called  upon  by  insurance  companies 
to  make  extensive  reports  even  in  cases  of  minor  injuries  attended 
by  him,  for  the  privilege  of  having  an  opportunity  for  collecting  an 
inadequate  fee  for  his  services.  This  does  not  compare  to  the  in- 
fringement on  his  professional  right  to  exercise  his  judgment  in 
the  selection  of  a  hospital,  operator,  or  consultant  in  extreme  cases. 
He  is  summarily  advised  that  he  must  refer  his  patient  to  so-and-so 
at  such-and-such  a  place.  Gentlemen,  while  it  true  we  have  de- 
parted in  many  ways  from  the  customs  and  methods  of  the  ancient 
coimtry  doctor,  let  us  hold  with  all  vigor  to  his  personal  interest  and 
responsibility  for  the  welfare  of  his  patient,  vmder  any  and  all  cir- 
cumstances. We  must  not  allow  commercialism  to  interfere  with 
this  professional  obligation.     The  watchword  of  the  day,  is  "effi- 


AFFECTIONS   OF   THE    SUBMAXILLARY   GLAND  167 

ciency,"  and,  while  the  commercial  spirit  has  entered  to  stay,  there 
is  a  Une,  beyond  which,  commercial  methods  cannot  be  applied, 
without  the  destruction  of  the  true  professional  spirit  and  obligation. 

AFFECTIONS   OF  THE  SUBMAXILLARY  SALIVARY 

GLAND 

By  Randolph  Winslow,  M.D. 

Projessor  of  Surgery 

I  have  been  much  impressed  with  the  infrequency  of  pathological 
conditions  of  the  submaxillary  and  subhngual  saHvary  glands.  In 
a  professional  experience  of  more  than  forty  years  I  have  met  with 
only  a  few  ailments  of  the  submaxillary  gland,  and  as  far  as  I  can 
recall  none  of  the  subhngual — except  possibly  some  cases  of  ranula. 
When  we  consider  the  location  of  these  structures  with  their  ducts 
opening  into  the  septic  cavity  of  the  mouth,  and  hence  liable  to 
mfection,  it  is  remarkable  that  inflammatory  disorders  are  so  seldom 
seen.  Also  it  is  remarkable  that  glands  that  are  so  active  func- 
tionally, from  infancy  to  old  age,  should  be  so  httle  hable  to  neo- 
plasms. 

Mumps.  The  most  frequent  affection  of  the  parotid  gland  is 
mumps,  which,  however,  but  seldom  affects  the  other  salivary  glands; 
indeed,  I  do  not  know  that  it  involves  the  sublingual  glands  at  all, 
but  I  do  know  that  the  submaxillary  may  be  involved,  as  one  of  my 
own  children  was  taken  with  a  painful  sweUing  under  the  jaw,  which 
corresponded  with  this  gland  in  shape  and  situation,  and  a  few  days 
later  he  was  seized  with  a  bilateral  parotitis.  Both  of  these  condi- 
tions subsided  in  the  usual  time  and  he  made  an  uncomplicated 
recovery. 

Salivary  calculus.  Concretions  may  form  in  the  ducts  of  any  of 
the  sahvary  glands,  but  they  occur  most  frequently  in  Wharton's 
duct,  the  outlet  of  the  submaxillary  gland.  It  may  form  a  hard 
mass  in  the  floor  of  the  mouth  which  may  be  mistaken  for  a  malig- 
nant growth.  We  should,  therefore,  bear  in  mind  this  fact  before 
we  do  an  extensive  operation  for  the  removal  of  a  supposed  carcinoma 
of  the  floor  of  the  mouth. 

Ranula.  This  is  a  cystic  dilatation  of  the  ducts  of  several  glands 
situated  under  the  tip  of  the  tongue.  It  is  frequently  due  to  an 
obstruction  of  one  of  the  ducts  of  the  subhngual  gland,  in  which 


i 


168  RANDOLPH   WINSLOW 

case  it  forms  a  cystic  tiimor  projecting  upwards  into  the  buccal 
cavity.  If  the  ranula  forms  in  Wharton's  duct  there  will  probably 
be  a  cystic  mass  projecting  downwards  below  the  lower  jaw.  The 
treatment  will  depend  upon  the  gland  involved,  and  will  be  either 
excision  of  a  large  portion  of  the  sac,  with  packing  of  the  resulting 
cavity,  or  ablation  of  the  respective  gland. 

Abscess.  In  consequence  of  infection  traveling  from  the  mouth 
down  the  ducts,  inflammation  and  abscess  occasionally  occur  in 
these  glands.  I  have  met  with  a  remarkable  case  of  this  character 
which  I  desire  to  place  on  record. 

Case  1.  C.  W.,  male,  age  60  years,  a  farmer  by  occupation  con- 
sulted me  about  a  hard  lump  mider  the  jaw,  in  the  left  submaxil- 
lary triangle.  This  had  been  noticed  for  several  weeks  and  was  in- 
creasing in  size.  His  family  and  past  history  were  imimportant, 
and  he  had  enjoyed  good  health  all  his  hfe.  He  denied  any  vene- 
real disease.  He  declined  to  have  the  growth  removed.  About 
a  week  later  he  returned  with  a  great  increase  in  the  size  of  the 
lump,  which  was  now  as  large  as  a  hen's  egg,  firm  to  the  touch  and 
but  slightly  movable.  On  admission  his  temperature  was  100° 
and  there  was  more  or  less  pain  and  discomfort. 

A  diagnosis  of  malignant  neoplasm  of  the  submaxillary  salivary 
gland  was  made  and  immediate  removal  recommended. 

On  December  1,  1900,  the  mass  was  excised  without  difficulty. 
It  was  hard,  and  when  cut  open  proved  to  be  the  submaxillary  gland 
forming  a  thick  walled  sac  containing  nearly  an  ounce  of  creamy 
pus  in  which  was  found  the  barb  or  head  of  some  kind  of  grass  or 
grain.  It  is  probable  that  he  had  had  a  stalk  of  grass  or  hay  in 
his  mouth,  the  barb  of  which  became  detached  and  entered  Whar- 
ton's duct  and  finally  passed  into  the  gland  itself.  He  was  dis- 
charged "Cured"  in  two  weeks. 

Neoplasms.  The  submaxillary  and  sublingual  glands  are  sub- 
ject to  the  same  neoplasms  as  the  parotid  but  with  nothing  like  so 
great  frequency.  The  tumors  occurring  in  these  regions  are  usually 
mixed  in  structure  owing  to  their  relation  to  the  branchial  clefts. 
In  my  own  experience  I  have  met  with  only  one  case  of  tumor  of 
the  submaxillary  gland  and  none  of  the  subHngual. 

Case  2.  M.  G.,  white,  female,  age  24  years,  admitted  March 
17,  1914,  married  and  has  two  children.  She  first  noticed  a  lump 
in  the  left  submaxillary  region  when  she  was  six  years  of  age.  It 
remained  stationary  until  she  was  sixteen  years  old,  when  it  reached 


PERFORATED    GASTRIC    ULCER  169 

its  present  size  and  has  not  increased  much  since.  The  patient's 
health  is  unimpaired  and  she  comes  to  hospital  to  have  the  growth 
removed.  The  tmnor  is  about  the  size  of  an  ordinary  hen's  egg 
and  is  irregular  in  shape.  It  is  very  hard  and  firm,  painless  and 
without  increased  heat  of  surface.  It  is  freely  movable  and  unat- 
tached to  the  skin  but  seems  to  be  attached  to  the  deep  tissues. 
There  are  no  lymphatic  glandular  enlargements. 

A  clinical  diagnosis  of  tmnor  of  the  submaxillary  salivary  gland 
was  made. 

Operation  on  March  20,  1914.  The  mass  was  removed  without 
difficulty  and  the  patient  was  discharged  four  days  later. 

Anatomical  diagnosis,  "Fibro-chondro — myxoma  of  the  submaxil- 
lary salivary  gland." 

Tumors  of  the  salivary  glands  are  said  to  occur  in  the  proportion 
of  10  of  the  parotid  to  1  of  the  submaxillary,  while  the  sublingual 
gland  is  affected  in  only  one  per  cent  of  all  cases.  The  tumors, 
of  course,  may  be  either  benign  or  malignant,  and  their  chief  pecaliar- 
ity  is  due  to  the  fact  that  they  are  usually  composed  of  several  di- 
verse tissues. 

PERFORATED  GASTRIC  ULCER  AND  DUODENAL 
ULCER  WITH  REPORT  OF  A  CASE 

By  Richard  Shea,  M.D. 
Mercy  Hospital,  Baltimore,  Md. 

This  condition  offers  a  most  interesting  study  as  to  diagnosis, 
symptomology  and  treatment.  The  prognosis  depends  solely  on 
the  early  recognition  of  the  existing  condition  with  prompt  and 
proper  surgical  treatment,  for  the  treatment  is  entirely  a  surgi- 
cal procedure. 

The  cases  I  will  report  are  those  occurring  on  Dr.  McGlannan's 
service  at  the  Mercy  Hospital  since  December,  1914,  and  are  all  of 
the  perforative  type  of  either  gastric  or  duodenal  ulcer. 

The  previous  history  when  it  can  be  obtained  is  an  important 
factor  in  making  a  proper  diagnosis,  for  in  the  vast  majority  of 
these  cases  there  is  a  history  of  previous  indigestion  of  ulcer  type 
for  some  time  prior  to  the  perforative  stage,  although  in  some  cases 
the  perforation  occurs  without  any  previous  history  whatever. 

The  etiology  of  ulcers  is  still  a  disputed  question,  among  the 
various  theories  given  are :  infection  and  interference  with  the  cir- 


170  RICHABD    SHEA 

culation  of  the  mucous  membrane  of  the  stomach.  That  trauma, 
muscular  exertion  and  excessive  ingestion  of  food  and  alcohol  play 
an  important  role  in  the  perforative  stage  of  ulcers  is  imdoubtedly 
true.  In  the  cases  presented  perforation  occured  in  thi'ee  cases 
while  the  patient  was  at  work  and  one  after  excessive  use  of  alcohol 
for  ten  days  prior  to  perforation. 

The  signs  and  symptoms  of  perforating  ulcer  can  be  put  in  no 
clearer  or  more  concise  way  than  has  been  done  by  Dr.  Deaver  in 
his  article  on  this  subject.  He  says,  "The  leading  symplom  is  pain, 
the  leading  sign  is  rigidity,  the  leading  clue  is  a  history  of  previous 
indigestion  of  ulcer  type,  vomiting  is  almost  constant  and  is  a  symp- 
tom of  value.-'  He  further  states,  "The  pain  and  rigidity  are  invar- 
iably present,  the  suggestive  history  is  occasionally  lacking."  "This 
is  a  practical  picture  of  perforated  ulcer,  if  it  is  remembered  and  all 
the  rest  forgotten  I  am  convinced  that  more  diagnoses  will  be  made 
than  are  at  present,"  and  again,  "The  attempt  to  place  any  other 
symptom  in  the  same  plane  of  importance  with  those  just  mentioned 
will  in  individual  cases  result  in  disaster." 

Pain  is  sudden  and  violent  and  its  character  is  described  as 
"sharp,"  "cutting,"  "burning,"  or  "stabbing"  but  no  matter 
how  it  is  described  the  fact  remains  that  it  is  constant.  Its  loca- 
tion is  epigastric,  in  the  midhne  usually  when  it  is  gastric  ulcer  and 
to  the  left  of  the  midline  when  it  is  duodenal,  its  great  tendency  is 
to  radiate  to  the  right  ihac  region  and  for  this  reason  the  appendix 
is  diagnosed  as  the  cause  of  the  condition  but  the  history  of  onset 
will  usually  clear  up  any  doubt  in  the  diagnosis. 
r^-Tenderness  is  early  and  marked  and  usually  epigastric.  While 
there  is  a  tendency  to  a  generalized  tenderness  over  the  abdomen 
the  point  of  maximum  tenderness  is  usually  well  localized  in  the 
epigastrium. 

Rigidity  occurs  early  and  is  one  of  the  chief  diagnostic  signs.  It 
rapidly  assumes  the  boardy  like  belly  and  is  described  as  such. 
Deaver  says,  "There  is  no  condition  in  which  the  upper  abdominal 
rigidity  is  so  early  and  so  marked  as  in  perforated  ulcer." 

Vomiting  when  it  occurs  and  is  blood  stained  is  an  important 
diagnostic  sign. 

Shock  in  these  cases  is  variable,  depending  entirely  on  the  general 
condition  of  the  patient  at  the  time  of  perforation,  the  ability 
of  the  patient  to  withstand  pain,  and  the  duration  of  the  perforation. 

Obliteration  of  liver  dullness  may  or  may  not  be  present  in  the 


PERFORATED    GASTRIC    ULCER 


171 


cases  that  are  seen  early,  this  sign  depending  mostly  on  the  size  of 
the  perforation  and  the  degree  of  localized  peritonitis. 

The  treatment  of  perforated  gastric  and  duodenal  ulcers  is  purely 
a  surgical  procedure  and  the  prognosis  depends  on  whether  or  not 
it  is  instituted  early,  the  earlier  the  case  is  seen  after  the  perforation 
the  better  the  prognosis. 

Simple  closure  of  the  perforation  with  a  purse  string  suture  and 
reenforcing  it  with  Lembert  sutures  is  the  best  procedure  in  most 
cases.  At  the  present  time  considerable  has  been  written  about 
doing  immediate  gastro-enterostomy  but  this  seems  an  unnecessary 
risk  in  the  presence  of  a  localized  or  general  peritonitis.  Another 
important  factor  against  it  is  the  prolongation  of  the  operatioti. 

The  question  of  drainage  in  these  cases  is  very  important,  drains 
should  be  inserted  down  to  the  ulcer,  both  kidney  fossa,  and  the 
pelvis  should  be  drained.  The  reason  for  this  is  the  gravitation  of 
the  fluid  from  the  perforation  down  along  the  colon  and  into  the 
pelvis,  also  along  the  border  of  the  mesentery  and  into  the  left  kid- 
ney fossa. 


SYMPTOMS 

n 

0 

z 
o 
< 

«  s 

p.    |M 

2  ^ 

Hi 

«  P  s 

(3  6-  H 
Q 

OPERATION 

6 

a 
Cm 

•a 
S 

a 

a 

m  2 
O  B 

•>.y 

a 
a 

a 
■3 

P 

-a 

'B 

hows 

days 

2233 

+ 

+ 

Duodenal 

10 

McBurney  and 

High 
Rt.  Rectus 

Ulcer 

Kidney  fossae 
Pelvis 

27 

R 

7011 

+ 

+ 

+ 

+ 

Duodenal 

4 

McB. 

H.  Rt.  Rectus 

Ulcer 

Kidney  fossae 
Pelvis 

34 

R 

8253 

+ 

+ 

+ 

+ 

Duodenal 

25 

L.  &H. 
Rt.  Rectus 

Ulcer 

Kidney  fossae 
Pelvis 
Left  flank 

D 

11867 

+ 

+ 

+ 

+ 

Gastric 

7 

Rt.  Rectus 

Ulcer 

Kidney  fossae 
Pelvis 

37 

R 

Case  11867;  colored,  male,  age  29,  admitted  to  Mercy  Hospital, 
November  3,  1916.  Complaining  of  pain  in  stomach.  This  attack 
of  acute  pain  came  on  while  lifting  a  heavy  piece  of  fm'niture,  about 


172  RICHARD    SHEA 

8.30  p.m.,  November  2,  1916.  He  was  able  to  finish  his  work  and 
went  to  his  home  where  he  appHed  hot  apphcations  to  abdomen  and 
drank  hot  water  in  his  efforts  to  get  rehef  from  the  pain.  Getting 
no  rehef  from  these  he  called  Dr.  Michaelson  who  diagnosed  his 
condition  as  perforated  gastric  ulcer  and  advised  him  to  go  to  the 
hospital  immediately.  On  admission  his  temperature  was  98.2,  pulse 
65,  respiration  18.  On  examination  the  abdomen  showed  a  slight 
distention,  marked  rigidity,  which  was  general;  pain  and  tenderness 
which  was  epigastric.  The  point  of  maximum  intensity  was  in  the 
midline  of  the  epigastrium.  White  blood  count  was  13,400  and 
a  differential  white  count  at  this  time  showed  84  per  cent  poly- 
nuclear  cells. 

Immediate  operation  was  advised.  Patient  was  given  morphia, 
grain  I,  and  atropine  grain  xiir  hypodermatically,  before  being  taken 
to  operating  room.  Ether  anesthesia  was  used;  iodine  technique 
in  preparation. 

A  right  rectus  incision  made  at  the  level  of  the  umbilicus,  the  fas- 
cia and  muscles  separated  in  the  hne  of  their  fibers,  the  peritoneum 
opened  and  the  abdominal  cavity  was  found  filled  with  yellowish 
fluid,  as  much  of  this  as  was  possible  was  mopped  out  with  large 
gauze  sponges,  the  caecum  was  picked  up  and  the  appendix  which 
was  post  caecal  and  extended  up  toward  the  liver  examined.  As 
much  as  could  be  examined  was  found  normal  and  the  appendix 
therefore  was  left  intact.  The  incision  was  enlarged  upward  into  the 
epigastrium.  The  stomach  was  secured  and  examined,  on  the  ante- 
rior wall  about  two  inches  from  the  pylorus  and  about  midway 
between  the  greater  and  lesser  curvatures  a  perforation  about  | 
inch  in  diameter  was  found,  from  which  fluid  was  escaping.  The 
perforation  was  closed  with  a  purse  string  suture  and  reinforced 
with  Lembert  sutm-es. 

For  drainage  a  cigarette  drain  was  inserted  down  to  the  ulcer, 
one  into  each  kidney  fossa,  and  four  into  the  pelvis. 

The  wound  was  closed,  the  peritoneum,  muscles  and  fascia  were 
sutured  with  chromic  cat  gut  and  the  skin  mth  silk  worm  gut. 
Dressings  were  applied  and  the  patient  returned  to  bed  in  good 
condition. 

He  was  put  up  in  the  Fowler  position.  Solution  of  sodium 
bicarbonate  and  glucose  one  ounce  each  to  500  cc.  of  water  given 
by  rectum  continuously  for  eight  hours.  Morphia,  in  ^w  grain  doses 
every   two   hours   given  when  needed.     Nothing  was  allowed  by 


HOSPITAL    NOISES  173 

mouth  but  small  quantities  of  cracked  ice  for  the  first  thirty-six 
hours,  after  this  small  quantities  of  water  and  at  the  end  of  seventy- 
two  hours  he  was  given  liquid  diet.  On  the  fifth  day  he  was  given 
restricted  soft  diet,  this  was  gradually  increased  until  on  the  eight- 
eenth day  regular  diet  was  given.  At  no  time  during  convales- 
cence did  the  patient  have  any  nausea  or  vomiting,  nor  complain 
of  any  symptoms  referable  to  the  gastric  condition. 

The  patient  has  recently  returned  to  the  hospital  for  examination 
and  apparently  is  free  from  any  gastric  disturbance. 

HOSPITAL  NOISES^ 

By  Erwin  E.  Mayer,  M.D. 
Mercy  Hospital 

The  subject  of  hospital  noises  is  one  which  rarely  receives  the  inter- 
est it  should,  on  account  of  the  general  prevalent  idea,  that,  all 
hospitals  are  quiet.  Having  been  an  interne  of  one  of  the  leading 
hospitals  of  Baltiinore  for  three  (3)  years,  and  having  had  an  oppor- 
tunity in  that  tmie  to  visits  all  the  hospitals  in  that  city,  I  have  ob- 
served many  things  of  interest ;  and  have  been  particularly  impressed 
with  inside  hospital  noises. 

In  a  large  city  a  great  many  of  the  hospitals  are  located  in  a  part 
of  the  city  where  more  or  less  noise  from  the  outside  is  a  constant 
occurrence,  and  is  very  difficult  to  control,  but  noises  on  the  inside, 
can  be  controlled,  and  easily  so,  if  cooperation  will  only  take  place. 

To  the  members  of  the  visiting  staffs,  vvho  spend  only  a  few  hours 
in  the  hospital  daily,  the  many  little  noises  may  not  appear  as  obvi- 
ous as  they  do  to  the  patients,  who  spend  many  days  in  their  rooms, 
or  to  those  of  us,  who  spend  the  greater  part  of  each  day  in  the 
hospital.  Then  again,  the  degree  of  noise  is  much  greater  to  an  ill 
person,  than  it  would  be  to  one  who  is  well  and  walking  about. 
The  two  miportant  questions  to  decide  therefore,  are: 

1.  The  production  of  noises. 

2.  The  elimination  of  noises. 

Let  me  give  you  a  short  list  of  noises  which  1  jotted  down  in  one 
hour  while  walking  through  a  hospital,  all  of  which  could  have  been 
easily  rectified. 

L  Elevator  bell. 

^  Read  before  the  Hospital  Conference  Association  of  Maryland. 


174  ERWIN   E.    MAYER 

2.  Scraping  of  buckets  along  marble  halls,  picking  up  and  setting 
down  of  buckets,  allowing  the  handle  to  fall  to  the  side  of  iron  waste 
buckets. 

3.  Slamming  of  doors  all  over  the  hospital. 

4.  Dusting  of  pieces  of  furniture  with  broom  or  brush,  upsetting 
or  striking  handle  of  brush  against  them. 

5.  General  loud  talking  all  over  the  hospitals — this  includes  visit- 
ors, nurses,  doctors,  orderHes,  helpers  on  the  halls  and  wards.  Con- 
versations on  halls  or  stairs  by  colored  help,  especially  accompanied 
by  loud  and  boisterous  laughing.  This  is  orte  of  the  principal  sources 
as  it  causes  much  comment  by  patients. 

6.  Absence  of  rubber  heels,  especially  of  nurses  and  internes. 

7.  General  loud  talking  in  wards,  whistHng,  laughing,  exchanging 
greetings  across  the  halls.     General  noises. 

8.  Falling  of  dishes,  keys,  trays,  brooms,  pans;  falling  of  things  in 
general  which  could  be  prevented  by  a  Httle  more  care. 

9.  Continual  ringing  of  telephone  without  being  answered.  This 
is  a  source  of  annoyance  to  the  patients  which  could  be  eliminated. 

10.  Pulling  of  laundry  baskets  on  rollers,  in  and  out  of  the  elevators 
and  then  down  the  halls  with  jerks. 

1 1 .  Gathering  of  doctors  on  the  wards  for  conversation,  other  than 
medical  should  not  take  place.  This  is  also  one  of  the  corrections 
which  the  internes  could  easily  do. 

12.  Bells  for  calling  nurses  and  doctors. 

It  can  readily  be  seen  by  this  Hst  that  a  great  many  of  these  noises 
could  be  eliminated,  by  a  Httle  cooperation.  We  have  tried  to  over- 
come one  of  the  chief  sources  of  noise — the  calluig  of  residents  and 
nurses,  by  installing  the  silent  system.  Nurses  and  doctors  are 
called  by  means  of  lights  and  not  bells. 

In  many  of  the  large  hospitals,  nurses  and  doctors  are  still  called 
by  bells;  and  in  others  the  megaphone  system  is  used,  In  the  Mercy 
Hospital  of  Baltimore,  both  of  these  noises  are  not  in  use  any  longer; 
and  the  use  of  the  silent  call  system  has  taken  the  place  of  much  of 
this  unnecessary  disturbance. 

The  telephone  still  remains  the  one  difficult  noise  to  control. 

In  our  day  the  telephone  is  absolutely  essential  for  conveying  and 
obtaining  information  from  all  the  different  departments  of  the  hos- 
pital. This  of  course,  means  the  almost  constant  ringing  of  the 
telephone  bell.  A  large  hospital  having  in  the  neighborhood  of  80 
to  100  telephone  stations  with  an  active  service  must  depend  chiefly 


HOSPITAL   NOISES  175 

on  the  nurses  or  attendants^to  answer  the  calls.  Each  one  of  these 
may  be  engaged  in  his  or  her  respective  duties,  and  the  telephone 
keeps  ringing  until  answered.  This  being  the  age  of  invention,  we 
are  looking  for  the  individual  who  will  throw  the  telephone  bell 
into  discard  and  give  us  instead,  a  silent  telephone  call.  The  three 
big  noises  would  then  be  eliminated  and  it  still  remains  for  hearty 
cooperation  to  make  the  hospitals  absolutely  noiseless.  Now,  in 
closing,  let  me  just  add  a  few  words. 

COOPERATION 

How  often  have  we  heard  the  remark  that  this  or  that  hospital  is 
noisy.  The  hospital  itself  is  not  noisy,  but  the  people  who  consti- 
tute the  personnel  and  the  staffs  of  the  hospital,  are  noisy.  A  care- 
less helper  who  simply  does  the  washing  or  the  scrubbing  of  the  floors 
can  be  more  trouble  to  the  hospital  and  the  patients,  than  one  would 
imagine. 

A  greeting  called  the  length  of  the  hall  or  ward  by  one  doctor  to 
the  other  in  the  spirit  of  friendship  can  be  heard  by  a  nervous  pa- 
tient, and  might  mean  the  naming  of  that  hospital  as  noisy. 

It  stands  to  reason  then,  that  everybody  connected  with  the  hos- 
pital, should  be  made  to  understand  what  constitutes  unnecessary 
noises  and  how  their  prevention  can  be  maintained.  Thoughtless- 
ness and  indifference  are  two  of  the  very  worst  producers.  The  in- 
dividual whether  it  be  male  or  female,  doctor  or  nurse,  executive  or 
attendant,  visitor  or  convalescent  patient,  elevatorman  or  scrub- 
women, chief  of  the  visiting  staff  or  interne;  each  attache  of  the  hos- 
pital must  enter  into  the  spirit  of  making  his  or  her  own  individual 
hospital,  the  one  quiet  place,  where  the  sick  can  find  shelter,  relief, 
solitude  and  rest,  which  is  so  essential  to  their  convelascence.  All 
our  well  known  authors  of  medical  literature  lay  special  stress  on 
treatment,  and  among  the  first  few  words  one  will  generally  find 
rest — and  just  following  it — both  physical  and  mental.  Mental 
rest  needs  quiet  and  it  is  for  the  sake  of  the  patients,  the  individual 
patients,  that  we  should  make  every  effort  to  eliminate  the  little 
noises  as  well  as  the  big  ones. 

The  real  solution  to  the  problem  is:  Hearty  Cooperation. 


176  THE    CHAMBERS    MEMORIAL   FUND 

THE  CHAMBERS  MEMORIAL  FUND 

The  Alumni  Association  of  the  College  of  Physicans  and  Surgeons, 
has  undertaken  the  collection  of  a  fund  for  the  purpose  of  provid- 
ing a  portrait  and  memorial  of  Dr.  J.  W.  Chambers. 

The  letter  printed  below  has  been  sent  to  the  members  of  the 
P.  &  S.  Alumni.  The  committee  will  be  glad  to  have  a  contribution 
from  any  friend  of  Dr.  Chambers  who  has  not  received  the  letter. 

The  list  will  remain  open  until  April  10,  1917. 

The  undersigned  committee  has  been  appointed  by  the  Alumni  Associa- 
tion to  collect  a  fund  for  the  purpose  of  providing  a  portrait  and  memo- 
rial of  Dr.  J.  W.  Chambers,  who  died,  January  21,  1917. 

Dr.  Chambers  was  graduated  from  the  College  of  Physicians  and  Sur- 
geons in  1878,  and  has  served  continuously  in  various  capacities  ever 
since.  During  these  thirty-nine  years  he  endeared  himself  to  successive 
classes,  and  became  one  of  the  most  distinguished  of  our  alumni. 

We  hope  that  the  prompt  and  generous  response  to  this  appeal,  made 
to  his  friends  and  colleagues,  fellow  alumni  and  former  students,  will  in- 
dicate his  deserved  popularity. 

Please  send  your  contribution  to  Dr.  C.  E.  Brack,  Calvert  and  Sara- 
toga Streets,  Baltimore,  who  will  act  as  treasurer  for  the  fund. 

Alexius  McGlannan,  Chairman, 

W.  J.  Todd, 

C.  E.  Brack, 

Harry  Friedenwald, 

W.  R.  McKenzie, 

Standish  McCleary. 

February  1,  1917. 
Dear  Dr.  Brack: 

Was  pained  at  news  of  Dr.  Chambers'  death.  Enclosed  find  my  bit  towards 
the  portrait. 

Hope  to  see  you  this  spring.     Kindest  regards. 

J.  G.  Simmons. 

February  5,  1917. 
Dr.  C.  E.  Brack, 

Baltimore,  Md. 
Sir: 

Please  find  my  little  mite.  Hope  it  will  be  received  in  the  spirit  given. 
We  are  growing  older  and  as  time  moves  down  the  path  we  grow  fewer  in 
numbers.     1  remember  our  good  Dr.  Chambers  as  demonstrator  of  anatomy. 

Success  to  all. 

D.  S.  Fisher. 


THE    CHAMBERS    MEMORIAL    FUND  177 

February  2,  1917 
Deak  Dr.  Bback: 

Enclose  find  my  check  for  Chambers  memorial  fund.  1  hope  you  will 
succeed  in  this  undertaking.  If  you  want  any  more  from  me  please  let  me 
hear  from  you.  Am  sorry  to  hear  of  Dr.  Chambers'  death.  1  certainly  did 
think  a  lot  of  him.  He  was  a  grand  man  and  was  a  fine  teacher  and  1  will 
never  forget  him. 

Yours  fraternally, 

W.  G.  Shaw. 

Philadelphia,  Pa.,  February  7,  1917. 
Dr.  Chas.  Brack, 

College  of  Physicians  and  Surgeons, 
Calvert  and  Saratoga  Streets,  Baltimore. 
My  Dear  Brack: 

Please  find  enclosed  check  to  apply  on  memorial  fund  for  Dr.  Chambers' 
portrait.  Should  you  not  receive  enough  in  contributions  to  make  up  the 
necessary  balance,  please  advise  me  of  what  is  needed  and  1  will  gladly  make 
further  contribution. 

With  kindest  regards,  1  am,  very  truly  yours, 

W.  S.  Blaisdell. 

Trenton,  N.  J.,  February  7,  1917 
C.  E.  Brack,  M.D. 
Baltimore,  Md. 
My  Dear  Doctor: 

The  medical  profession,  more  so  our  beloved  institution,  sustains  a  tre- 
meadous  loss.  The  very  numerous  and  practical  instructions,  which  I  have 
derived  from  our  late  Dr.  Chambers,  will  always  refresh  him  in  my  mem- 
ory. My  donation  may  be  a  small  one,  yet  I  gladly  contribute  toward  the 
Memorial  Fund  of  my  venerated  instructor. 

Sincerely, 

B.  H.  Tadeusiak,  '15. 

February  7,  1917. 

Dear  Dr.  Brack: 

1  was  more  than  grieved  to  learn  of  our  beloved  Dr.  J.  W.  Chambers'  death. 

Like  our  departed  friend  and  teacher  Dr.  Wm.  Simon,  we  "P  and  S"  men  all 

loved  and  respected  him.     1  am  sure  there  is  not  one  alumnus  who  does  not 

feel  this  great  loss. 

Very  truly  yours, 

W.  E.  Delaney,  '91 

February  8,  1917. 
To  the  Chambers  Memorial  Committee, 

Baltimore,  Md. 
Dear  Sirs: 

Upon  the  roll  of  honor  of  great  men  who  have  lived  and  labored  in  the 
medical  world  will  be  carried  the  name  of  Dr.  John  W.  Chambers  of  Balti- 


178  THE   CHAMBERS    MEMORIAL    FUND 

more.  That  he  was  a  doctor  of  medicine  was  a  mere  incident,  it  was  the 
man  who  counted.  He  gave  honor  to  the  medical  profession,  the  title  only 
giving  deserved  recognition  to  the  man. 

A  great  man  has  fallen,  men  will  say,  but  Dr.  Chambers  was  great  because 
he  had  prepared  himself  to  be  great.  It  was  not  chance  that  brought  him 
fame,  but  because  he  had  done  those  things  that  bring  fame.  His  life  gave 
honor  to  the  community,  his  deeds  added  dignity  and  glory  to  the  profession. 
That  he  is  dead  brings  sadness  to  every  one  that  knew  him.  He  had  affec- 
tions placed  in  the  hearts  of  the  lowliest,  his  friendship  was  a  gem  of  great 
price  with  the  highest. 

Tributes  many  in  high  terms  are  paid  the  memory  of  this  splendid  man, 
but  there  are  none  higher  than  that  regret  which  is  in  the  hearts  of  the  many 
lowly  patrons  for  whom  he  largely  gave  his  life.  Not  alone  kind  and  cour- 
ageous, but  he  possessed  wisdom  and  a  breadth  of  vision  which  placed  him 
in  the  front  ranks  of  men,  a  man  whom  his  fellows  always  delighted  to  honor. 

C.  M.  Van  Poole,  '80. 

February  9,  1917 
Dr.  C.  E.  Brack, 

College  of  Physicians  and  Surgeons,  Baltimore. 
My  Dear  Doctor: 

The  message  of  Dr.  Chambers'  death  came  as  a  shock  to  me.  1  think  of 
him  as  a  young  man,  bright,  active,  always  pleasant  and  affable.  He  was  a 
fine  man,  a  gentleman,  and  an  excellent  surgeon.  His  loss  will  be  keenly 
felt  by  the  college,  and  by  a  host  of  former  students. 

1  enclose  herewith  a  modest  cheque,  which,  1  feel,  is  not  at  all  commen- 
surate with  my  esteem  for,  nor  indebtedness  to,  him. 

Very  sincerely  yours, 

L.    L.    DOANE. 

February  15,  1917. 
Dr.  C.  E.  Brack, 

Baltimore,  Md. 
My  Dear  Doctor  : 

The  letter  from  the  Alumni  Committee  soliciting  contributions  to  the 
"Chambers  Memorial  Fund,"  is  the  first  intimation  1  have  had  of  the  death 
of  my  colleague  and  friend. 

Dr.  Chambers  and  1  were  both  members  of  the  class  of  78,  and  were  inti- 
mately associated  during  our  college  days,  and  in  all  these  years,  1  have  ever 
cherished  a  high  regard  and  sincere  affection  for  him. 

1  am  sure  he  was  one  of  the  best  men  I  have  ever  known,  and  1  believe,  the 
best  doctor. 

1  consider  it  a  privilege  to  make  my  small  contribution  to  this  fund,  and 
will  cheerfully  contribute  more  if  you  think  it  will  be  needed. 
With  kindest  regards,  1  am. 

Sincerely  yours, 

H.  M.  Brown. 


CORRESPONDENCE  .  179 

February  12,  1917. 
Dear  Sir  : 

Enclosed  please  find  check  as  my  contribution  to  the  Fund.  It  is  with 
deep  sorrow  and  regret  that  1  learned  of  Dr.  Chamber's  death. 

1  always  had  the  highest  regard  for  his  ability  as  a  surgeon  and  his  sterling 
qualities  as  a  man. 

Very  sincerely  yours, 

Jno.  W.  Coughlin. 

Taunton,  February  13,  1917. 
Dr.  Charles  E.  Brack, 

College  of  Physicians  and  Surgeons, 
Balthnore,  Md. 
Dear  Doctor: 

1  received  your  letter  stating  with  much  feeling  the  death  of  our  valued  Dr. 
Chambers.  1  am  sincerely  grieved  at  his  passing,  as  1  think  the  university 
has  lost  a  very  valuable  man  from  its  faculty. 

Enclosed  you  will  find  check  which  you  may  add  to  your  fund  for  the  pur- 
pose you  have  indicated. 

1  trust  that  you  and  the  rest  of  the  boys  at  the  college  are  prosperous  and 
well.    1  am  still  at  the  same  hospital  that  1  entered  upon  leaving  school. 

Sincerely  yours, 

Horace  G.  Ripley. 

CORRESPONDENCE 

AMERICAN  AMBULANCE  FIELD  SERVICE 
Sections  Sanitaires  de  l' Ambulance  Americaine  aux  Armies 

Si:6ge  Central. 
21.  Rue  Raynouard 
Paris  (xvi'^^) 

November  22,  1916. 
To  the  Editor: 

May  I  ask  the  privilege  of  your  columns  to  call  to  the  attention  of  your 
readers  the  pending  formation  by  the  American  Ambulance  Field  Service  in 
France  of  several  new  sections  and  the  opportunity  which  will  be  available 
during  the  next  few  months  for  an  additional  number  of  volunteers  who  are 
interested  in  France  and  who  would  like  to  be  of  service  there? 

We  have  already  more  than  200  cars  driven  by  American  volunteers,  mostly 
imiversity  men,  grouped  in  sections  which  are  attached  to  divisions  of  the 
French  army.  These  sections  have  served  at  the  front  in  Flanders,  on  the 
Somme,  on  the  Aisne,  in  Champagne,  at  Verdun  (five  sections  including  120 
cars  at  the  height  of  the  battle),  in  Lorraine  and  in  reconquered  Alsace,  and 
one  of  our  veteran  sections  has  received  the  signal  tribute  from  the  French 
army  staff  of  being  attached  to  the  French  army  of  the  Orient  in  the  Balkans. 


180  CORRESPONDENCE 

We  are  now  on  the  point  of  greatly  enlarging  our  services  for  the  last  lap  of 
the  war,  and  a  considerable  number  of  new  places  are-  available. 

Every  American  has  reason  to  be  proud  of  the  chapter  which  these  few  hun- 
dred American  youths  have  written  into  the  history  of  this  prodigious  period. 
Each  of  the  several  sections  of  the  American  .Ambulance  Field  Service  as  a 
whole  and  fifty-four  of  their  individual  members  have  been  decorated  by  the 
French  Army  with  the  Croix  de  Guerre  or  the  Medaille  Militaire  for  valor  in 
the  performance  of  their  work. 

The  nature  of  this  work,  and  the  reason  for  these  remarkable  tributes  from 
the  army  of  France  is  clearly  presented  in  the  official  report  of  the  first  year 
and  a  half's  services  published  by  Houghton,  Mifflin  &  Co.,  of  Boston,  under 
the  title  of  Friends  of  France. 

Information  as  to  the  requirements  of  and  qualifications  for  the  service 
will  be  gladly  sent  by  Henry  D.  Sleeper  from  the  Boston  Headquarters  of 
the  Field  Service,  at  Lee  Higginson  &  Co.,  40  State  Street,  or  may  be  obtained 
from  Wm.  R.  Hereford,  at  the  New  York  Headquarters,  14  Wall  Street. 

The  American  Ambulance  Field  Service  has  recently  been  described  by  a 
member  of  General  Joffre's  staff  as  "The  finest  flower  of  the  magnificent  wreath 
offered  by  the  Great  America  to  her  little  Latin  sister." 

There  are  surely  many  more  of  the  sterling  youths  of  America  who  would 
like  to  add  their  little  to  that  wreath. 

A.  Piatt  Andrew, 
Inspector  General,  American  Ambulance  Field  Service. 

Baltimore,  Md., 

February  9,  1917. 
The  Faculty  of  Physic  of  the  University  of  Maryland  School  of  Medicine 
and  College  of  Physicians  and  Surgeons  at  their  regular  monthly  meeting  on 
Tuesday,  February  6,  resolved  that  a  committee  should  be  appointed  to  draft 
suitable  resolutions  on  the  death  of  Dr.  Harry  W.  Stoner,  Associate  in  Pathol- 
ogy and  Bacteriology,  and  Assistant  Chief  of  the  Bureau  of  Bacteriology, 
State  Department  of  Health  of  Maryland.  The  following  resolutions  were 
adopted  by  the  committee : 

"In  the  death  of  Dr.  Stoner  the  Medical  School  has  lost  a  faithful  and  ef- 
ficient teacher  and  investigator  in  bacteriology  and  immunology,  whose  name 
was  well-known  both  here  and  abroad  and  whose  work  has  been  favorably 
criticized  both  by  reviewers  and  investigators.  By  his  gentle,  faithful  and 
lovable  character  he  endeared  himself  to  all  his  friends  and  associates,  and 
his  untimely  death  while  in  the  full  vigor  of  his  career  leaves  a  vacancy  both 
in  the  Medical  School  and  the  State  Department  of  Health  which  will  be  diffi- 
cult to  fill." 

It  was  also  resolved  that  a  copy  of  these  resolutions  should  be  sent  to  the 
family  of  Dr.  Stoner. 

[signed] 

Wm.  Royal  Stokes, 
Charles  E.  Simon, 
Standish  McCleary. 


BULLETIN 

OF    THE 

University  of  Maryland  School  of  Medicine 

AND 

College  of  Physicians  and  Surgeons 


Publication  Committee 

Randolph  Wikslow,  A.M.,  M.D.,  LL.D.  Wm.  S.  Gardnbb,  M.D. 

J.  M.  H.  Rowland,  M.D. 

Nathan  Winslow,  A.M.,  M.D.,  Editor 

Aaaoeiate  Editort 

Albert  H.  Casboll,  M.D.  Andrew  C.  Gillis,  A.M.,  M.D. 

John  Evans,  M.D. 


Death  of  Professor  John  Wesley  Chambers,  M.D.,  Sc.D. 

We  are  called  upon  to  lament  the  premature  death  of  Dr.  John 
Wesley  Chambers,  one  of  the  professors  of  surgery  in  the  combined 
medical  school  of  the  University  of  Maryland  and  College  of  Physi- 
cians and  Surgeons.  Death  has  visited  our  circle  all  too  frequently 
in  the  past  two  years  and  has  deprived  us  of  many  of  our  brightest 
Hghts.  Amongst  these  Dr.  Chambers  holds  a  prominent  place. 
He  was  a  graduate  of  the  College  of  Physicians  and  Surgeons,  in 
in  the  Class  of  1878,  and  had  practised  his  profession  continuously 
in  this  city  since  that  time.  He  was  an  able  surgeon  and  had  a 
large  surgical  following,  and  was  in  addition  a  skilled  medical  con- 
sultant. He  was  a  development  of  the  period  when  a  physician 
was  supposed  to  be  expert  in  all  branches  of  the  medical  art  and  he 
came  very  near  to  filling  this  requirement.  He.  was  consecutively 
demonstrator  of  anatomy,  professor  of  anatomy,  professor  of  opera- 
tive and  cHnical  surgery  and  finally  professor  of  surgery  in  his  alma 
mater;  and  when  the  merger  of  the  College  and  the  University  took 
place  he  was  elected  a  professor  of  surgery  in  the  joint  school.  He 
was  known  as  a  genial,  approachable  man;  one  who  took  an  especial 
interest  in  the  yoimg  and  struggling  physician.  He  died  while 
on  a  visit  to  a  friend  at  Du  Bois,  Pennsylvania,  aged  about  60. 

181 


182  editorials 

Death  of  Professor  Pearce  Kintzing,  M.D. 

We  also  regret  to  have  to  announce  the  death  of  another  member 
of  the  Board  of  Instruction,  Pearce  Kintzing,  M.D.,  professor  of 
clinical  medicine.  Dr.  Kintzing  had  only  been  connected  with 
the  University  for  a  few  months  and  consequently  was  not  well 
known  to  a  large  number  of  the  alumni.  He  was  an  active,  ener- 
getic man  of  marked  ability,  a  skillful  practitioner  and  an  excellent 
teacher,  and  we  feel  sure  that  we  have  met  with  another  severe  loss. 
He  is  said  to  have  had  a  phlebitis  of  the  arm,  for  which  an  unsuc- 
cessful operation  was  performed.     He  was  56  years  of  age. 

Is  Cancer  Either  Contagious  or  Hereditary? 

The  subject  of  cancer  is  of  perennial  interest.  The  disease  is  so 
widespread  and  apparently  is  increasing  at  such  a  rapid  rate  that 
its  consideration  must  always  be  both  interesting  and  instructive. 
At  the  tenth  annual  meeting  of  the  Association  of  Life  Insurance 
Presidents  held  in  New  York  on  December  14  and  15,  1916,  Mr. 
Arthur  Hunter,  actuary  for  the  New  York  Life  Insurance  Com- 
pany, made  an  address  upon  the  subject  of  the  contagiousness  or 
hereditability  of  cancer.  He  prefaced  his  remarks  with  the  state- 
ment that  last  year  80,000  persons  in  the  United  States  died  of  can- 
cer and  that  in  the  past  decade  nearly  three-quarters  of  a  million  of 
our  citizens  had  succmnbed  to  this  malady.  This  is  not  only  a 
large  but  a  rapidly  increasing  death  rate,  as  in  1900,  according  to 
the  census,  the  deaths  from  cancer  were  in  the  proportion  of  63  to 
100,000,  while  in  1915  the  ratio  had  increased  to  81  per  100,000, 
or  approximately  30  per  cent.  It  is  probable  that  some  of  this 
increase  can  be  explained  by  greater  accuracy  in  diagnosis  and 
greater  care  in  making  out  reports  but,  even  allowing  for  a  certain 
degree  of  error  from  these  sources,  it  is  evident  that  a  marked  in- 
crease in  the  incidence  of  the  disease  has  taken  place.  Notwith- 
standing a  vast  amount  of  experimentation  and  of  study  the  cause 
of  cancer  has  not  been  discovered  and  a  cure  has  not  been  found. 
Mr.  Hunter  rightly  says  that  there  is  much  anxiety  on  the  part  of 
those  whose  relatives  have  died  of  cancer  in  regard  to  the  contagious- 
ness or  danger  of  hereditary  transmission  of  the  disorder.  He  does 
not  beheve  that  cancer  is  the  result  of  contagion,  and  offers  the 
conclusions  derived  from  a  study  of  20,000  applications  for  insur- 


EDITORIALS  183 

ance  in  one  company,  received  in  August,  1916.  Of  this  number 
488  were  found  in  which  it  was  stated  that  one  parent  had  died  of 
cancer,  and  4  in  which  both  parents  were  stated  to  have  died  of 
this  disease. 

In  analyzing  these  cases  it  was  found  that  "in  100  or  about  20 
per  cent,  the  other  parent  had  also  died  but  of  other  causes  than 
cancer,  and  at  an  average  age  of  thirteen  years  younger  than  the 
parent  who  died  of  cancer." 

"In  115  cases,  or  24  per  cent,  the  other  parent  had  also  died  of 
other  causes  than  cancer,  but  at  an  average  age  of  fourteen  years 
older  than  the  parent  who  died  of  cancer." 

"In  273  cases,  or  56  per  cent,  the  other  parent  was  living  and  was 
not  cancerous.  The  average  age  of  the  273  living  parents  was  5| 
years  greater  than  the  average  age  at  death  of  the  273  parents  who 
had  died  of  cancer." 

A  most  significant  fact  is  that  out  of  20,000  applications  for  in- 
surance in  only  4  was  it  stated  that  both  parents  had  died  of  cancer. 

In  view  of  the  above  facts  it  would  appear  that  there  is  but  little 
danger  of  the  propagation  of  cancer  by  direct  contact;  but  one 
cannot  avoid  the  fear  that  cancer  may  result  from  contact  in  some 
cases. 

HEREDITABILITY   OF   CANCER 

Mr.  Hunter  is  equally  emphatic  in  his  opinion  that  cancer  is 
seldom  or  never  transmitted  as  a  hereditary  disease;  and  he  bases 
his  opinion  on  the  following  facts.  He  studied  the  histories  of 
persons  insured  in  six  companies,  both  parents  having  died  of  can- 
cer prior  to  date  of  application  for  insurance.  Of  472  grandparents 
of  the  insured,  the  cause  of  death  was  given  in  234  cases,  of  which 
only  2  were  from  cancer.  In  184  of  these  the  cause  of  death  is 
stated  to  have  been  "old  age,"  the  average  age  at  death  having 
been  82.  Eleven  of  the  grandparents  were  living  at  an  average 
age  of  over  80.  In  227  cases  the  appHcants  did  not  know  the  cause 
of  death  of  their  grandparents.  Mr.  Hunter  says,  "that  while  the 
above  evidence  is  not  conclusive,  it  is  reasonable  to  conclude  that 
if  only  2  died  of  cancer  out  of  234  parents  of  persons  who  died  of 
cancer,  that  disease  is  not  hereditary." 

Moreover  of  175  sons  and  daughters,  both  of  whose  parents  had 
died  of  cancer,  and  who  lived  beyond  the  age  of  40,  19  or  11  per  cent 
had  died  from  various  diseases  at  an  average  age  of  52,  but  there 


184  EDITORIALS 

were  no  deaths  from  cancer.  The  remaining  156  were  hving  at  an 
average  age  of  53  years.  Of  102  sons  and  daughters,  who  hved 
beyond  50  years,  there  were  9  deaths  from  various  causes  but  none 
from  cancer.     The  remaining  93  were  Hving  at  an  average  age  of  59. 

In  another  series  of  cases  the  results  were  practically  the  same. 
Of  139  sons  and  daughters,  both  of  whose  parents  had  died  of  can- 
cer, who  lived  beyond  40,  8  died  at  an  average  age  of  51,  but  none 
of  these  from  cancer.  Of  47  who  Hved  beyond  the  age  of  50,  3  died 
at  an  average  age  of  56  but  none  from  cancer. 

Where  one  parent  only  had  died  of  cancer  the  results  of  investi- 
gation is  equally  striking,  as  in  810  sons  and  daughters  above  the 
age  of  40,  there  were  Hving  765,  deaths  from  known  causes  45, 
deaths  from  cancer  2. 

Of  those  over  50  years  of  age,  the  living  were  267,  deaths  from 
known  causes  21,  deaths  from  cancer  1. 

This  is  less  than  was  to  be  expected  according  to  the  mortality 
statistics  of  the  Census  Bureau. 

Family  history  of  policyholders  who  had  died  from  cancer:  125 
persons  whose  death  was  attributed  to  cancer,  among  the  policy 
holders  of  a  large  insurance  company,  in  1915,  were  taken  at  ran- 
dom and  their  family  history  investigated.  Of  500  grandparents, 
known  causes  of  death  were  of  271,  deaths  from  cancer  1,  living  14, 
unknown  causes  of  death  215.  Of  250  parents  the  known  causes 
of  death  were  202,  cancers  and  tumors  8,  unknown  causes  16,  and 
living  32. 

Of  course  we  have  made  only  a  brief  epitome  of  the  investigations 
of  Mr.  Hunter,  who  smns  up  his  conclusions  as  follows:  "Certainly 
the  statistics  show  that  a  man  or  a  woman,  one  or  both  of  whose 
parents  died  from  cancer,  is  no  more  likely  to  die  from  that  dis- 
ease than  those  whose  family  history  was  free  from  that  blemish. 
Men  and  women  who  are  in  anxiety  of  mind  on  account  of  the  ap- 
pearance of  cancer  in  their  ancestry  or  immediate  family  may  dis- 
miss such  anxieties  as  there  is  no  statistical  evidence  at  the  present 
time  that  the  disease  of  cancer  is  transmitted  by  inheritance  in 
mankind." 

Death  of  Dr.  Harry  Wilbur  Stoner 

As  we  go  to  press  we  receive  the  notice  of  the  death  of  Dr.  Harry 
W.  Stoner,  associate  in  bacteriology  and  pathologj^  in  the  Univer- 
sity, and  assistant  bacteriologist  to  the  State  Board  of  Health, 
after  a  brief  illness  of  pneumonia. 


DEATHS  185 

Dr.  Stoner  was  a  most  meritorious  man.  With  very  meager 
means  he  worked  his  way  through  the  medical  school  by  assisting 
in  the  pathological  laboratory;  and  upon  his  graduation  in  1907, 
he  was  made  an  assistant  bacteriologist  to  the  State  Board  of  Health 
and  assistant  in  the  pathological  and  bacteriological  laboratories 
of  the  University  of  Maryland. 

He  was  highly  esteemed  by  all  those  with  whom  he  worked  for 
his  fidelity  to  duty,  as  well  as  for  his  intelligent  services.  In  addi- 
tion to  his  other  work  he  was  pathologist  to  the  Maryland  General 
Hospital  and  to  the  Presbyterian  Eye,  Ear  and  Throat  Hospital. 
He  filled  a  special  niche  in  the  school  and  it  will  be  difficult  to  re- 
place him.     His  loss  is  a  severe  one. 

DEATHS 

Dr.  J.  Ford  Thompson,  U.  of  M.  1857,  79  years  old,  one  of  the 
best  known  surgeons  in  Washington,  died  February  2,  at  George 
Washington  University  Hospital,  after  an  illness  of  more  than  a  year. 
He  was  born  in  St.  Mary's  County,  Maryland,  March  20,  1837, 
and  would  have  celebrated  the  eightieth  anniversary  of  his  birth 
next  March.  He  was  educated  in  public  and  private  schools  in 
St.  Mary's  Coimty  and  at  the  Rittenhouse  Academy,  Washington. 

He  began  his  practice  in  Washington  in  partnership  with  Dr. 
M.  V.  B.  Bogan.  He  was  at  one  time  acting  assistant  surgeon  in 
the  United  States  Army.  Dr.  Thompson  was  surgeon  to  Provi- 
dence, Columbia  Hospital  for  Women,  Emergency,  Children's, 
George  Washington  University  and  Garfield  Memorial  Hospitals. 

During  the  Civil  War  he  served  both  in  military  hospitals  in 
Washington  and  in  the  field.  He  was  professor  of  anatomy  in 
Columbian  Medical  College  and  afterward  served  for  more  than 
20  years  as  professor  of  surgery  at  that  college.  He  was  a  member 
of  the  American  Medical  Association,  the  American  Surgical  Asso- 
ciation and  president  of  the  Medical  Association  of  the  District  of 
Columbia  in  1881-82.  At  the  time  of  his  death  he  was  an  emeritus 
professor  of  George  Washington  University. 

During  his  period  of  active  practice  in  this  city  Dr.  Thompson 
attended  many  prominent  men.  He  was  called  when  President 
Garfield  was  shot,  and  was  family  physician  for  a  nimiber  of  Cabinet 
members  at  that  tune. 

Dr.  Thompson  was  one  of  the  first  physicians  to  realize  the  value 


186  DEATHS 

of  specialization  in  medical  practice,  and  early  in  his  career  gave  up 
all  his  practice  except  that  of  surgery.  He  also  was  one  of  the  first 
men  in  this  country  to  receive  the  degree  of  doctor  of  medicine  from 
the  University  of  Stockholm.  He  graduated  from  the  Medical 
School  of  the  University  of  Maryland  in  1857. 

Dr.  Irving  Drury  Chaney,  U.  of  M.  1906,  of  Mt.  Airy,  Maryland, 
died  at  Portland  Manor,  the  home  of  his  mother,  after  a  few 
months  of  illness,  due  to  exhaustion  caused  by  overwork  in  his 
profession. 

Dr.  Chaney  was  the  only  son  of  Mrs.  W.  Frank  Chaney  and  the 
late  Irving  D.  Chaney.  After  graduating  from  the  medical  depart- 
ment of  the  University  of  Maryland  he  located  at  Mt.  Airy, 
Maryland. 

Dr.  Pearce  Kintzing,  prominent  physician  and  author,  who  was 
one  of  the  first  physicians  to  introduce  the  carbolic  acid  treatment 
of  lockjaw  in  Baltimore,  died  at  Franklin  Square  Hospital  after  an 
illness  of  two  weeks  from  grip. 

Born  in  Lock  Haven,  Pennsylvania,  Dr.  Kintzing  would  have  been 
56  years  old  the  day  after  his  death.  He  was  a  son  of  Tench  Cox 
Kintzing  and  Mary  Musser  Dunn.  He  was  educated  at  the  Lock 
Haven  High  School  and  Lafayette  College,  and  graduated  in  medicine 
in  1887.     He  came  to  this  city  as  a  practitioner  the  following  year. 

He  was  a  member  of  the  University  Club,  the  Medical  and  Chirur- 
gical  Faculty  of  Maryland,  the  City  Medical  Society  and  the  Alli- 
ance Frangaise.  In  1892  he  married  Miss  Theo  Helen  Jacobsen, 
who  survives  him.  She  is  at  present  in  Rome.  He  was  a  wide 
traveler  and  had  visited  places  in  Mexico  and  Canada,  traveled 
nearly  all  over  the  United  States  and  seen  all  of  Europe,  with  the 
exception  of  Russia,  Norway  and  Sweden.  He  had  crossed  the 
ocean  16  times. 

Dr.  Kintzing  was  author  of  Signs  of  Internal  Diseases,  Trans- 
jnission  of  Racial  Characteristics  and  Long  Life  and  How  to  Attain  It, 
and  was  engaged  in  writing  another  book,  Maryland  as  Seen  from 
an  Automobile. 

Dr.  Benjamin  Rush  Ridgeley,  U.  of  M.  1847,  one  of  the  oldest 
residents  of  Baltimore  County,  died  of  pneumonia  February  2  at 
the  home  of  his  son,  Joshua  Ridgeley,  447  East  Twenty-fifth  Street, 


DEATHS  187 

after  an  illness  of  10  days.  He  was  94  years  old.  Before  his  ill- 
ness, which  followed  a  bad  cold,  Dr.  Ridgeley  was  exceptionally 
active. 

He  was  born  at  Barretts  Dehght,  near  Warren,  Baltimore  County, 
and  lived  there  all  his  life,  the  property  having  been  the  home  of 
his  family  for  more  than  200  years.  He  was  graduated  from  the 
University  of  Maryland  in  1847  and  practiced  a  short  time,  then  went 
to  farming,  a  pursuit  in  which  his  family  followed  for  generations. 

Dr.  James  Howell  Billingslea,  U.  of  M.,  1864,  one  of  the  most 
prominent  physicians  of  Maryland  and  a  lifelong  resident  of  West- 
minster, Md.,  died  at  his  home  January  28  froma  paralysis,  after 
an  illness  of  only  a  few  days,  aged  74  years. 

Dr.  BiUingslea  was  the  son  of  the  late  Dr.  L.  L.  Bilhngslea,  who 
died  many  years  ago.  The  son  studied  medicine  with  the  late  Dr. 
Joshua  W.  Hering  and  was  graduated  from  the  Maryland  Univer- 
sity, succeeded  to  the  practice  of  the  father,  and  for  fifty-two  years 
continued  to  look  after  the  sick.  He  was  president  of  the  Union 
National  Bank,  president  of  the  Consolidated  Public  Utilities  Com- 
pany, president  of  the  Democratic  Advocate  Publishing  Company, 
vice-president  of  the  Smith- Yingling  Canning  Company  and  a  direc- 
tor of  the  Carroll  County  Mutual  Fire  Insurance  Company. 

Dr.  Harry  Wilbur  Stoner,  44  years  old,  assistant  bacteriologist 
to  the  State  Board  of  Health,  died  at  his  home,  2301  East  Madison 
Street,  after  a  brief  illness  of  pneumonia. 

He  was  the  son  of  Upton  L.  and  Mrs.  Margaret  Stoner,  of  Fred- 
erick County.  He  was  graduated  in  the  public  schools  of  the  state 
and  was  graduated  in  medicine  from  the  University  of  Maryland 
in  1907.  The  following  month  he  was  appointed  assistant  bacteri- 
ologist and  the  next  year  was  appointed  assistant  in  bacteriology 
and  pathology  of  the  University  of  Maryland.  He  also  had  charge 
of  the  laboratories  at  the  Maryland  General  Hospital  and  at  the 
Presbyterian  Eye,  Ear  and  Throat  Hospital. 


188  ITEMS 

ITEMS 

Dr.  John  T.  Burrus  wishes  to  announce  that  he  is  specializing  in 
surgery  and  gynecology,  High  Point,  North  Carolina. 

Prof.  James  M.  H.  Rowland  left  for  Chicago  on  February  2  to 
attend  the  educational  conference  called  by  the  Council  on  Medical 
Education  of  the  American  Medical  Association,  and  the  annual 
meeting  of  the  Association  of  American  Medical  Colleges. 

The  War  Department  has  assigned  Captain  Taylor  E.  Darby, 
U.  S.  Army,  U.  of  M.  1904,  as  instructor  in  military  medicine  to 
the  senior  class,  for  the  rest  of  the  session.  Captain  Darby  is  well 
remembered  at  the  University  as  an  excellent  student  and  will 
make  a  very  acceptable  instructor. 

Officers  elected  at  the  annual  meeting  of  Baltimore  County  Medi- 
cal Society,  January  17, 1917: 
President,   Dr.   Martm  F.   Sloan. 
Vice-President,  Dr.  J.   Percy  Wade. 
Secretary,  Dr.  F.  W.  Keating. 
Treasurer,  Dr.  F.  W.  Keating. 

Delegate  to  Medical  and  Chirurgical  Faculty,  Dr.  Josiah  S.  Bowen. 
Alternate,  Dr.  L.  G.  Smart, 

The  following  passed  the  examinations  of  the  State  Board  of  Medi- 
cal Examiners  in  December,  1916,  and  have  received  their  licenses 
to  practice  in  Maryland:  Chas.  C.  Childs,  Ralph  Cohen,  Geo.  B. 
Crist,  Israel  J.  Feinglos,  Maurice  Feldman,  Bowers  H.  Growt,  Howel 
I. Hammer,  Gerald  L.  Higgins,  Frank  S.  Hundley,  George  McLean, 
Abraham  Schapiro,  Edward  F.  Syrop,  Carl  M.  Van  Poole,  Harry 
L.  Rogers. 

Dr.  Edward  J.  Bernstein,  Class  of  1887,  announces  that  he  has 
removed  from  Kalamazoo,  Michigan,  to  Detroit,  and  that  he  has 
had  remarkable  success  in  his  new  venture.  He  has  been  offered 
the  position  of  head  of  the  Eye  and  Ear  Department  in  the  large 
Jewish  clinic  and  a  similar  position  on  the  staff  of  Grace  Hospital. 
Dr.  Bernstein  practiced  his  specialty  in  Baltimore  for  many  years, 
moving  to  the  Northwest  about  1905. 


ITEMS  189 

Judge  Thomas  delivered  recently  the  opinion  of  the  Court  of 
Appeals  in  the  case  of  Redwood  vs.  Howison,  holding  that  Mrs. 
Ridie  M.  Howison,  and  Mrs.  Eleanor  Howison  Witherspoon,  mother 
and  sister,  respectively,  of  the  late  Mrs.  Minnie  Howison  Coale, 
who  was  the  wife  of  Dr.  R.  Dorsey  Coale,  are  entitled  under  his  will 
to  the  whole  of  his  estate,  which  amounts  to  about  $60,000.  The 
court  thus  affirms  the  decree  of  Judge  Bond  in  Circuit  Court  No.  2 
of  Baltimore  City. 

Dr.  Coale  made  his  will  in  1901,  giving  his  estate  to  his  wife  after 
payment  of  his  debts  and  the  adjustment  of  his  accounts  with  the 
University  of  Maryland.  Mrs.  Coale  died  in  1911,  her  husband 
surviving  until  1915  without  changing  his  will.  The  representatives 
of  Dr.  Coale,  who  are  Mrs.  Mary  B.  Redwood,  a  sister,  and  George 
Buchanan  Coale,  a  minor  nephew,  claimed  that  by  the  true  construc- 
tion of  certain  clauses  of  the  will  the  estate  devolved  on  them  in 
consequence  of  the  death  of  Mrs.  Coale  before  the  death  of  her 
husband. 

Captain  Taylor  E.  Darby,  of  the  Medical  Corps  of  the  United 
States  Army,  has  been  recommended  by  the  Surgeon  General  as 
lecturer  on  Military  Medicine  and  Sanitation  at  the  University 
of  Maryland.  The  appointment  of  Captain  Darby  has  not  yet 
been  confirmed  by  the  War  Department,  but  will  probably  be  within 
a  few  days.  The  course  will  consist  of  thirty-two  lectures,  beginning 
on  February  14  and -continuing  until  the  end  of  the  session.  Captain 
Darby,  who  is  a  graduate  of  the  University  of  Maryland,  class  of 
1904,  has  just  returned  from  Mexico,  where  he  was  in  command  of 
an  ambulance  company.  His  headquarters  were  in  the  camp 
where  Lieut.  Nathan  Winslow,  editor  of  the  Bulletin,  was  stationed. 
According  to  Captain  Darby's  report,  the  former  editor  is  now  a 
seasoned  soldier  and  is  held  in  high  esteem  by  his  fellow-officers. 

At  a  meeting  of  the  Faculty  of  Physic  held  on  February  13,  1917 
Dr.  McGlannan  was  unanimously  elected  a  member  of  the  Faculty, 
with  the  title  of  Professor  of  Clinical  Surgery. 

Dr.  McGlannan  graduated  at  the  College  of  Physicians  and  Sur- 
geons in  1895  and  has  had  a  continuous  connection  with  his  alma 
mater  since  that  time.  He  is  an  active,  energetic  and  skillful  surgeon, 
and  has  become  widely  and  favorably  known  to  the  profession  of 
this  country  through  his  numerous  papers  on  surgical  subjects. 


190  MARRIAGES 

MARRIAGES 

A  marriage  license  was  issued  recently  to  George  P.  McGrath, 
whose  home  is  in  Jamaica,  and  Miss  Mary  M.  McCoUough,  a  nurse 
in  the  University  Hospital. 

Mr.  McGrath  is  one  of  the  British  government's  customs  officials 
in  Jamaica.     His  age  was  given  as  43  and  Miss  McCollough's  as  25. 

Two  nurses  of  the  University  Hospital  have  offered  their  resigna- 
tions, and  it  is  understood  that  both  will  marry  surgeons  of  the 
United  States  ArmJ^  One  pair  will  leave  immediately  for  Mexico, 
while  the  other  is  expected  to  go  to  Panama. 

Miss  Marian  Dil worth  and  Miss  Lulu  M.  Dorsey  of  Clarksville, 
Maryland,  are  the  nurses  who  have  decided  to  give  up  professional 
life.  A  license  was  issued  in  the  office  of  the  Clerk  of  the  Court  of 
CoEomon  Pleas  for  the  marriage  of  Miss  Dorsey  to  Dr.  Robert  B. 
HiU  of  the  United  States  Army.  Dr.  C.  Reid  Edwards  of  west 
North  Avenue  was  the  appHcant.  As  yet  no  hcense  has  been  issued 
at  the  local  marriage  bm'eau  for  the  wedding  of  Miss  Dilworth,  but 
it  is  understood  that  she  is  to  marry  a  Dr.  Wilson. 

According  to  Dr.  Edwards,  Dr.  Hill  has  been  ordered  to  INIexico. 
It  is  said  that  he  will  take  his  bride  with  him.  Friends  of  Dr.  Wilson 
say  that  he  will  go  to  Panama. 


BULLETIN 

OF  THE 

University  of  Maryland  School 
OF  Medicine 

AND 

College  of  Physicians  and 
Surgeons 

Successor  to  The  Hospital  Bulletin,  of  the  University  of  Maryland, 
Baltimore  Medical  College  News,  and  the  Journal  of  the  Alumni  Asso- 
ciation of  the  College  of  Physicians  and  Surgeons 

Vol.  I  MARCH,  1917  No.  8 

PREPARING  FOR  PREPAREDNESS 

By  S.  J.  Fort,  M.D. 

Professor  of  Materia  Medica  and  Pharmacology,  University  of  Maryland  School 
of  Medicine  and  College  of  Physicians  and  Surgeons 

The  campaign  for  the  betterment  of  the  feeble-minded  of  Maryland 
suggested  by  Dr.  Herring  and  about  to  be  inaugurated  by  this 
society  marks  an  epoch  in  the  history  of  the  state  and  will  take  its 
place  as  another  of  the  many  beneficent  schemes  for  which  the  medi- 
cal profession  as  a  whole,  and  the  State  Lunacy  Commission  as  the 
de  facto  influence,  has  become  celebrated. 

Outlines  of  the  general  plan  and  the  manner  by  which  the  cam- 
paign will  be  conducted  will  be  presented  to  your  honorable  body  by 
the  originator  and  others  upon  the  program.  It  falls  to  my  lot  as  a 
willing  assistant  to  call  your  attention  to  a  viewpoint  of  the  subject 
which  to  my  mind  is  of  great  importance  and  well  worthy  of  your 
consideration. 

One  of  the  chief  reasons  why  this  state  has  been  handicapped  in 
its  efforts  to  give  its  feeble-minded  population  adequate  care,  has 
been  lack  of  complete  data  as  to  the  actual  number  of  such  people 
in  the  state.  This  doubtful  and  uncertain  condition  has  been  due 
to  several  causes.  Investigations  in  the  past  have  been  conducted 
ia  a  more  or  less  desultory  manner,  through  no  fault  of  the  investi- 

191 


192  S.    J.    FORT 

gators,  but  largely  due  to  lack  of  proper  facilities.  You  are  well 
aware  of  the  fact  that  the  United  States  census  is  based  almost 
entirely  upon  estimated  number  rather  than  exact  figures,  for  which 
reason  our  knowledge  of  the  insane  and  feeble-minded  is  only  ten- 
tatively correct. 

Moreover  the  information  collected  upon  the  subject  of  the  feeble- 
minded is  vitiated  by  willful  misrepresentation  by  parents  or  rel- 
atives, or,  what  is  just  as  bad,  actual  ignorance  of  both  investigator 
and  investigatee. 

Assuming  that  this  is  true,  we  are  placed  in  the  position  of  the 
colored  brother  who  gave  his  recipe  for  fried  rabbit  by  stating 
"the  fust  thing  you  does  is  to  cotch  de  rabbit;"  and  the  first  thing  we 
must  do  is  to  obtain  an  accurate  idea  of  the  total  number  of  feeble- 
minded in  the  state  so  that  their  care  can  be  considered  in  terms  of 
dollars  and  cents,  both  for  the  present  and  for  the  future. 

In  this  connection  I  suggest  consideration  of  the  plan  to  make 
mental  defectiveness  a  reportable  condition,  just  as  we  report  other 
more  active  and  visible  diseases.  There  would  seem  to  be  no  reason- 
able objection  to  such  a  plan,  though  opposition  is  bound  to  occur 
from  those  upon  whom  the  blight  of  such  a  defective  member  of  the 
family  has  descended,  or  the  less  excusable  but  none  the  less  apparent 
lack  of  interest  in  such  reports  shown  by  the  profession  itself,  may 
be  exerted  against  it. 

Medical  students  are  now  taught  enough  about  mental  diseases  and 
defects  to  be  able  to  make  such  reports  with  accuracy,  and  these 
reports  followed  up  by  the  field  workers  of  the  Limacy  Commission 
would  serve  to  check  errors,  and  correct  and  gradually  supply  a 
mass  of  data  well  worth  tabulating  and  preserving  as  a  basis  of 
calculation,  and  interpretation. 

This,  however,  by  the  way.  The  subject  I  have  selected  may 
have  appeared  unapropos  to  the  main  question.  In  fact  a  member 
of  the  committee  preparing  the  program  when  he  heard  it,  wanted 
to  know,  "what  the  expurgated  adjective  had  preparedness  to  do 
with  the  feeble-minded?"  I  might  have  reminded  him  that  ac- 
cording to  the  peerless  William  J.  it  has  everything  to  do  with  the 
matter,  but  I  refrained.  The  connection  will  I  hope  be  more  obvi- 
ous after  I  have  explained  it  as  it  appears  to  me. 

Please  bear  in  mind  that  I  am  not  here  to  preach  a  propaganda 
either  for  or  against  preparedness  as  a  necessity  for  a  possible  but 
let  us  hope  an  altogether  improbable  war,  but  one  of  the  schemes 


PREPARING  FOR  PREPAREDNESS  193 

mapped  out  as  a  preparation  for  preparedness  is  universal  military 
training  with  probably  a  certain  amount  of  universal  military  service. 

This  scheme  if  it  is  properly  carried  out  means  far  m.ore  than 
training  young  men  to  fight  for  their  country.  It  means  a  nation- 
wide intensive  physical  and  mental  survey,  which  will  do  more  to 
separate  the  physically  and  mentally  fit  from  those  who  are  physically 
and  mentally  unfit  than  could  ever  occur  under  other  and  less 
searching  investigations.  We  can  carry  out  a  more  or  less  efficient 
survey  of  this  state  with  relation  to  its  feeble-minded  population, 
providing  adequate  resources  are  given  by  the  state  for  the  purpose. 

This  would  be  of  itself  of  vast  value  to  the  commonwealth  and  a 
worthy  example  for  other  states  to  follow,  but  with  the  resources 
of  the  Federal  Government  back  of  a  scheme  to  bring  together  each 
year  a  half  million  adolescents  for  military  training  affords  a  far 
wider  field  and  a  brighter  spot-light  through  which  and  by.  which 
a  better  knowledge  of  the  number  of  unfit  would  become  apparent. 

No  such  scheme  can  be  carried  out  to  its  logical  conclusion  without 
a  thorough  physical  examination  of  each  and  every  individual  called 
to  the  training  camps.  It  is  not  at  all  impossible  to  conceive  of  a 
cooperation  between  the  national  and  local  associations  of  mental 
hygiene  and  the  medical  corps  of  the  Army  and  Navy  in  making  this 
examination,  and  I  believe  this  would  obtain. 

Moreover,  no  sooner  will  this  law,  if  it  is  passed  by  Congress,  come 
into  effect  than  there  will  arise  a  widespread  demand  for  exemptions, 
which  of  itself  will  serve  to  bring  our  mental  as  well  as  physical 
defects  as  reasons  for  evading  the  law,  giving  still  another  avenue 
through  which  information  and  data  will  filter  to  be  properly  tabu- 
lated. 

Let  me  again  mention  that  universal  military  training  is  not  solely 
to  prepare  an  active  rather  than  a  standing  army  as  a  defensive 
proposition,  though  this  is  by  no  means  an  unimportant  consideration. 
It  is  going  to  show  the  country  just  where  we  stand  in  so  far  as  our 
resources  in  manhood  exist  and  prove  that  the  contention  of  some 
thinking  men  in  regard  to  a  decadence  in  virility  is  true  or  is  not 
true,  which  of  itself  will  go  far  towards  a  better  appreciation  of  the 
real  conditions  existing  at  the  present  time  in  this  respect. 

It  is  not  difficult  to  understand  how  such  training  applied  alike 
to  the  sons  of  the  rich  and  sons  of  the  poor  will  enable  us  to  deter- 
mine not  only  the  proportionate  number  of  those  who  are  unable 
to  keep  pace  with  their  brighter  brothers,  but  to  a  better  knowledge 


194  CHARLES    G.    HILL 

of  the  total  number  of  moral  defectives,  a  class  of  our  youth  which 
is  of  even  greater  concern  to  the  body  politic  than  the  more  definitely 
mental  defectives. 

That  the  Baltimore  County  Medical  Association  will  back  the 
proposed  state  survey  with  its  usual  energy  and  influence  goes 
without  saying,  and  there  is  no  necessity  for  me  to  urge  an  additional 
energy  at  this  time,  but  the  thought  I  have  endeavored  to  convey 
to  you  this  afternoon  seems  to  me  of  sufficient  importance  to  ask  a 
thoughtful  consideration  and,  if  possible,  both  an  individual  and 
collective  interest  in  this  proposed  national  movement,  which  should 
also  prove  of  benefit  to  the  state  as  well  as  the  nation. 

SOME  OBSERVATIONS  ON  THE  CARE  OF  THE  FEEBLE- 
MINDED IN  MARYLAND 

By  Charles  G.  Hill,  A.M.,  M.D. 
Arlington,  Maryland 

A  general  consideration  of  f  eeble-mindedness  would  be  like  writing 
a  history  of  the  human  race.  From  the  earliest  advent  of  man  upon 
the  planet  the  unborn  child,  or  the  helpless  infant,  either  by  accident 
or  disease,  was  arrested  in  his  development  and  remained  to  the 
end  of  his  life  a  more  or  less  helpless  being,  unable  to  cope  with  his 
environments  without  the  assistance  of  others.  That  many  survived 
at  all,  were  not  put  to  death  or  were  allowed  to  die  from  neglect  was 
due  to  that  divine  "instinct  for  the  care  of  the  helpless,  implanted  in 
the  human  heart  coincident  with  man's  creation,  looking  to  the 
perpetual  preservation  and  protection  of  the  race.  This  extended 
beyond  the  natural  family  ties,  for  the  amented  child  sometimes 
grew  apace,  and  with  a  sturdy  body  and  dwarfed  mind  wandered 
away  from  its  parental  cave  or  hut  and  doubtless  often  became  a 
nuisance  and  a  menace,  even  as  he  does  today,  but  a  beneficient 
superstition  that  "The  fool  was  God's  child"  and  dire  pimishment 
would  be  visited  upon  anyone  who  did  him  harm,  or  failed  to  give  him 
assistance  or  protection,  has  been  his. preservation  throughout  the 
ages,  and  even  among  uncivilized  races  the  fool  often  fared  better 
than  his  more  fortunate  brother.  It  is  therefore  somewhat  a  matter 
of  surprise  that  no  systematic  effort  had  been  made  to  better  the 
condition  of  this  unfortunate  class,  by  either  custody  or  training, 
imtil  about  the  year  1800,  when  Itard,  a  celebrated  physician  to  the 


CARE    OF   THE    FEEBLE-MINDED    INT    MARYLAND  195 

National  Institution  for  the  Deaf  and  Dumb  of  Paris,  attempted 
the  education  of  a  boy  found  wild  in  the  French  forests,  who  could 
speak  no  human  tongue  and  was  devoid  of  all  understanding  and 
knowledge.  This  was  abandoned  when  he  found  him  to  be  an  idiot 
instead  of  a  savage,  though  it  required  five  years  for  him  to  make 
this  discovery.  In  the  year  1818,  and  for  a  few  years  afterwards, 
several  idiotic  children  were  received  and  given  instructions  at  the 
Asylum  for  the  Deaf  and  Dumb  at  Hartford,  Connecticut,  and  a 
fair  degree  of  mental  and  physical  improvement  was  obtained. 
In  1828  Dr.  Ferret  of  Paris  attempted  to  teach  a  few  of  the  more 
intelligent  idiots,  confined  in  his  hospital,  to  read  and  write  and  to 
train  them  in  habits  of  cleanliness  and  order.  In  1831  and  1833  other 
efforts  were  made  in  France  in  public  institutions  and  private  schools. 
None  of  these  attempts,  however,  was  successful  enough  to  insure 
its  continuance.  In  1837  Dr.  E.  Seguin,  a  pupil  of  Itard  and  Esquirol, 
convinced  that  the  idea  was  not  entirely  visionary,  began  the  private 
instruction  of  idiots  at  his  own  expense.  Dr.  Seguin's  school  was 
visited  by  scientists  and  philanthropists  from  nearly  every  part  of 
the  civilized  world  and  other  schools  were  soon  established  in  many 
other  countries,  based  upon  these  methods.  It  was  as  late  as  1846 
when  the  efforts  of  Drs.  Connolly  and  Reed  led  to  the  establishment 
of  a  private  school  in  Bath,  England.  The  success  of  the  work  of 
Dr.  Seguin  soon  reached  America  and  many  efforts  were  made  to 
establish  such  training  schools,  and  many  times  were  such  attempts 
defeated  by  the  legislative  bodies  of  the  states.  It  was  not  until 
1848  that  Massachusetts  appropriated  $2500  for  the  purpose  of 
establishing  an  experimental  school,  which  three  years  afterwards 
was  converted,  by  incorporation,  into  a  permanent  institution.  In 
1851  New  York  fell  into  line  and  appropriated  $6000  for  a  similar 
purpose  and  Dr.  H.  B.  Wilbur  was  placed  in  charge.  In  his  first 
annual  report  the  aims  and  purposes  of  the  school  were  summed  up 
in  the  following  most  comprehensive  and  classical  language: 

We  do  not  propose  to  create  or  supply  faculties  absolutely  wanting;  nor 
to  bring  all  grades  of  idiocy  to  the  same  standard  of  development  or  discipline ; 
nor  to  make  them  all  capable  of  sustaining  creditably  all  the  relations  of  a 
social  and  moral  life;  but  rather  to  give  to  dormant  faculties  the  greatest 
possible  development,  and  to  apply  these  awakened  faculties  to  a  useful 
purpose  under  the  control  of  an  aroused  and  disciplined  will.  At  the  base  of 
all  our  efforts  lies  the  principle  that,  as  a  rule,  none  of  the  faculties  are  ab- 
solutely wanting,  but  dormant,  undeveloped,  and  imperfect. 


196  CHARLES    G.    HILL 

Thus  we  see  that  it  was  scarcely  more  than  three-score  years  ago 
that  the  humanity,  the  morality,  and  the  economy  of  this  great 
movement  entered  into  the  minds  and  hearts  of  the  people  and  loos- 
ened the  public  purse-strings,  and  beginning,  like  a  snowball  on  the 
hillside,  it  gradually  rolled  on,  always  gathering  momentum  and 
accretions.  Pennsylvania  was  the  third  state  to  take  up  the  work 
in  1852;  Ohio  followed  in  1857;  Connecticut  in  1858;  Kentucky  in 
1860;  Illinois  in  1865;  Iowa  in  1876;  Minnesota  and  Indiana  in  1879; 
"Kansas  in  1881;  California  in  1885;  New  Jersey  and  Maryland  in 
1888.  This  brings  us  down  to  the  incorporation  of  the  Maryland 
Asylum  and  Training  School  for  the  Feeble-Minded,  and  at  this 
time  the  "snowball"  had  grown  until  14  public  institutions  had  been 
incorporated  and  held  under  their  protecting  wings  6000  inmates, 
with  buildings,  grounds,  teachers  and  trainers  adequate  for  their 
purposes,  not  to  mention  the  number  of  private  schools  for  the 
feeble-minded  in  the  United  States  caring  for  several  hundred  more. 

It  would  be  interesting  to  pass  in  review  the  motives  and  the 
methods  which  led  to  the  creation  of  a  training  school  and  asylum 
for  aments  in  this  state,  but  time  does  not  permit  it  on  this  occasion. 
This  should  be  done,  however,  as  a  matter  of  history,  before  those 
of  us  who  were  witnesses  of  the  source  and  origin  of  the  inspiration 
for  such  a  movement  shall  have  been  succeeded  by  another  genera- 
tion. Naturally  the  necessity  for  such  an  institution  was  first  ex- 
perienced by  those  who,  having  charge  of  the  insane,  necessarily 
came  in  contact  with  the  most  turbulent  element  of  the  feeble- 
minded. Thus  it  is  easy  to  trace  the  origin  of  the  movement  to  a 
coterie  of  intelligent  philanthropists  centered  around  the  board  of 
directors  of  Springfield  Hospital,  then  the  only  state  institution 
for  the  care  of  the  insane.  In  all  probability  the  seed  was  first 
planted  by  the  late  Dr.  Richard  Gundry,  the  superintendent  of 
that  institution,  and  subsequently  nurtured  by  strong  public  char- 
acters who,  through  his  inspiration,  gave  to  this  movement  their 
zeal  and  ability  which  culminated  in  the  passage  of  an  Act  of  the 
General  Assembly,  approved  March  31,  1888,  and  signed  by  His 
Excellency,  Elihu  E.  Jackson,  then  Governor  of  Maryland.  Among 
those  who  labored  so  faithfully  for  the  passage  of  this  act,  and  who 
continued  to  give  their  services  to  this  cause,  and  became  members 
of  its  first  board  of  visitors,  were  Dr.  J.  Pembroke  Thom,  who  was 
the  first  president  of  our  board;  Hon.  Milton  G.  Urner,  the  second 
president,  and  Col.  Herman  H.  Stump,  the  third  president.     In 


ACIDOSIS  197 

addition  to  these  were  tiie  late  Dr.  John  Morris;  Mr.  James  A.  L. 
McClure;  Henry  King;  Thomas  Hill;  Levin  F.  Morris;  Charles 
Ridgely  Goodwin;  J.  Clarence  Lane;  J.  Walter  Carpenter;  Hon. 
Charles  B.  Roberts;  W.  P.  T.  Turpin.  These  have  been  succeeded  by 
other  members  as  one  by  one  they  dropped  from  the  ranks,  who 
have  continued  to  fight  the  battle  for  the  feeble-minded. 

"Both  gallantly  and  well, 
Each  stepping  where  the  other  stood,  the  moment  that  he  fell." 

ACIDOSIS 

By  W.  H.  Smith,  M.D.,  and  Arthur  M.  Shipley,  M.D. 
Baltimore,  Maryland 

During  the  past  few  years  a  great  deal  of  attention  has  been  paid 
to  the  study  of  the  regulation  of  the  body  fluids  as  regards  acidity 
and  alkalinity.  The  medical  profession  has  been  especially  interested 
in  the  condition  known  as  acidosis.  This  term  has  been  very  loosely 
applied  and  does  not  designate  a  definite  clinical  entity,  but  is 
applied  to  a  variety  of  conditions  in  which,  as  Sellards  expresses  it, 
there  is  general  impoverishment  in  bases  or  in  substances  that 
give  rise  to  bases.  The  impoverishment  in  bases  may  b  ■  due  to 
faulty  absorption,  to  an  unusual  loss  of  bases  from  the  body,  or  to 
their  being  neutralized  by  an  abnormal  amoimt  of  acids.  An  in- 
creased production  of  acids  may  result  from  the  production  of 
abnormal  acids,  or  as  Howland  suggests,  to  an  increase  in  normal 
acids  due  to  increased  formation  or  decreased  elimination.  At 
the  present  time,  it  is  impossible  to  estimate  what  are  the  normal 
amounts  of  bases  and  acids  in  the  body.  Probably  considerable 
variation  occurs  under  different  physiological  conditions,  and  it 
has  been  recently  emphasized  that  variations  occur  in  healthy 
persons  due  to  changes  in  elevation  above  sea  level. 

What  we  really  mean  by  acidosis  is  a  lowered  alkalinity  of  the 
blood  and  tissues  due  to  any  of  the  above  mentioned  causes,  so  that 
in  the  last  analysis  acidosis  means  a  lessened  quantity  of  carbonates 
in  the  blood.  This  prevents  the  blood  from  transmitting  the 
necessary  amount  of  acids  from  the  tissues  to  the  excretory  organs 
and  results  in  an  accumulation  of  acid  by-products  in  the  body. 

No  life  can  exist  in  an  acid  medium.  Natural  water  is  nearly 
always  alkaline.     Plants  will  not  grow  in  an  acid  soil.     Fertiliza- 


198  W.    H.    SMITH   AND    ARTHUR   M.    SHIPLEY 

tion  is  largely  adding  an  alkali  to  the  earth.  That  is  the  value  of 
lime  in  agriculture.  All  of  the  fluids  of  the  body  are  alkaline  except 
the  urine  and  gastric  juice.  The  blood,  bile,  and  cerebro-spinal 
fluid  have  a  very  fixed  alkalinity  and  will  take  care  of  large  quan- 
tities of  acid  without  appreciable  disturbance  of  reaction.  A  change 
in  the  blood  from  the  reaction  of  tap  water,  which  has  a  greater 
alkalinity  than  blood,  to  that  of  distilled  water,  which  is  more  acid 
than  blood,  would  result  fatally. 

The  body  is  constantly  making  acids  as  the  result  of  energy  and 
heat  formation.  Metabolism  breaks  up  alkaline  substances  and 
acid  by-products  are  formed.  Phosphoric  and  sulphuric  acid  are 
formed  from  oxidation  of  sulphur  and  phosphorus  in  proteins,  and 
CO2  from  the  oxidation  of  all  organic  matter.  Oxybutyric  acid  is 
formed  by  the  oxidation  of  fats.  Lactic  acid  and  uric  acid  are 
formed  and  may  leave  the  body  unchanged.  The  basic  salts  in  the 
blood  combine  with  those  acids.  But  it  must  be  borne  in  mind  that 
the  ability  of  the  blood  to  take  up  these  acids  is  strictly  Kmited,  as 
it  must  always  remain  an  alkaline  fluid. 

These  acids  are  eliminated  chiefly  by  three  avenues,  lungs,  kid- 
neys, and  sweat  glands.  Now  how  does  the  alkaline  blood  transmit 
these  acid  substances  to  these  organs  of  excretion- without  suffering 
a  fatal  disturbance  in  reaction?  In  twenty-four  hours,  the  CO2 
in  the  blood  is  the  chemical  equivalent  of  several  hundred  cubic 
centimeters  of  concentrated  HCl.  This  is  one  of  the  most  interesting 
and  difficult  questions  in  physiology  and  physiological  chemistry. 

The  regulation  of  the  alkalinity  of  the  body  may  be  compared 
with  regulation  of  body  temperature.  Every  one  knows  that  life 
can  only  be  continued  within  a  limited  range  of  temperature  varia- 
tion and  that  health  is  possible  only  in  a  far  more  restricted  range. 
Likewise  the  variation  of  the  body  fluids  must  possess  a  degree  of 
constancy  even  greater  than  the  body  temperature  if  a  normal 
condition  or  even  life  itself  is  to  continue. 

It  is  with  extraordinary  regularity  that  the  blood  maintains  a 
constant  reaction  that  is  slightly  alkaline,  and  it  is  largely  through 
the  work  of  Henderson  and  his  associates  that  we  have  become 
familiar  with  at  least  some  of  the  mechanism  by  which  the  reaction 
is  kept  so  constant. 

How  is  the  reaction  in  the  blood  kept  so  constant?  The  important 
constituents  of  the  blood  that  have  to  do  with  the  regulation  of  this 
reaction  are : 


ACIDOSIS  199 

1.  Sodium  bicarbonate  occurring  both  in  the  plasma  and  in  the 
cells. 

2.  The  acid  and  alkali  phosphates  of  sodium  and  potassium  found 
almost  entirely  within  the  red  blood  corpuscles. 

3.  The  proteins  also  play  some  part,  and  this  will  be  mentioned 
later. 

In  the  blood  and  lymph  we  have  the  sodium  salts  of  two  very 
weak  acids,  carbon  dioxide  and  phosphoric  acid.  In  the  blood  and 
lymph,  sodium  carbonate  (alkaline)  and  carbon  dioxid  (acid)  are 
both  present  to  give  a  nearly  neutral  reaction.  Similarly,  disodium 
hydrogen  phosphate  (alkaline)  and  monosodium  phosphate  (acid) 
are  present  in  proportion  to  give  a  nearly  neutral  reaction.  If  to 
the  blood  or  lymph  a  strong  acid,  e.g.,  oxybutyric,  lactic,  or  hydro- 
chloric be  added,  for  each  unit  of  strong  acid  introduced  into  the 
blood,  there  is  liberated  a  weak  acid  which  possesses  much  less 
power  of  altering  the  reaction.  From  the  weak  acids,  salts  are 
formed,  and  these  are  chiefly  sodium  phosphate  and  carbonate,  and 
to  the  formation  of  these  weak  salts,  the  namie  of  buffer  substances 
has  been  applied.  This  enables  the  sodium  bicarbonate  in  the  blood 
to  take  up  a  quantity  of  the  acids  without  the  blood  undergoing  an 
appreciable  change  in  reaction. 

In  these  ways,  the  blood  is  able  to  carry  acirl  by-products  from 
the  tissues  to  the  excretory  organs  without  suffering  a  serious  lessen- 
ing in  alkalinity. 

Now  how  are  these  acid  by-products  eliminated?  By  the  lungs, 
by  the  kidneys,  and  to  a  much  smaller  extent  by  the  sweat  glands. 
Carbonic  acid  is  liberated  by  the  lungs  and  phosphoric  acid  by  the 
kidneys. 

In  health,  CO2  tension  is  greatest  in  the  tissues,  less  so  in  the 
blood,  and  lowest  in  the  alveolar  air,  and  the  flow  is  constant  from 
high  to  low  tension. 

The  kidneys  excrete  an  acid  urine  from  an  alkaline  blood.  This 
liberates  alkaline  bases  in  the  blood,  which  take  care  of  large  quanti- 
ties of  acids.  It  is  the  acid  phosphate  that  is  removed,  leaving  the 
alkaline  base. 

The  body  has  another  means  of  defense  against  acid  accumulation, 
and  that  is  the  formation  of  an  alkali  ammonia,  which  is  formed  at 
the  expense  of  urea,  a  neutral  substance. 

In  health,  small  amounts  of  ammonia  are  always  formed  and 
neutralize  ffn  equal  amount  of  acid.     If  acid  be  introduced  into  the 


200  W.    H.    SMITH   AND    ARTHUR   M.    SHIPLEY 

body  or  formed  in  the  body  by  pathological  conditions,  the  body 
responds  with  an  increased  production  of  ammonia.  The  amount 
of  alkali  saved  to  the  body  in  normal  subjects  in  this  way  approxi- 
mates that  saved  by  the  process  of  acid  phosphate  excretion,  but  in 
diseased  conditions  may  be  seven  times  as  much.  This  provision 
of  metabolism  by  which  the  system  is  protected  against  the  deleteri- 
ous effects  of  increased  acidity  by  neutralization  of  acid  compounds 
with  ammonia  is  of  the  greatest  importance,  as  the  fixed  alkalies 
of  the  tissues  are  thereby  maintained  in  their  usual  concentration 
unless  the  pathological  process  be  extreme.  It  must  be  remembered 
that  while  a  high  ammonia  coefficient  always  arouses  the  suspicion 
of  acidosis,  that  there  must  be  other  confirmation,  as  a  high  ammonia 
coefficient  may  result  from  diabetic  causes,  and  on  the  other  hand 
fatal  acidosis  may  occur  without  any  considerable  increase  in  the 
ammonia  coefficient. 

Proteins  also  play  a  part  in  maintaining  an  alkaline  reaction  on 
account  of  their  amphoteric  character  and  ability  to  combine  with 
acids  and  bases,  but  the  results  of  these  combinations  are  as  yet 
imperfectly  understood. 

It  is  perfectly  clear  from  what  has  been  said  that  a  continual 
introduction  of  acids  into  the  body  fluids  will  sooner  or  later  result 
in  a  depletion  of  the.body's  natural  means  of  defense,  and  as  a  result 
we  have  the  condition  known  as  acidosis.  Acidosis  may  mean  car- 
bohydrate starvation.  When  there  are  not  sufficient  carbohydrates 
in  the  food  the  body  will  metabolize  proteins  and  fats  in  order  to 
maintain  heat  and  energy.  These  foods  when  oxidized  liberate  a 
large  quantity  of  acid  by-products  which  may  give  a  higher  acid 
content  in  the  tissues  than  can  be  handled  by  the  bases  in  the  blood. 

This  is  especially  true  of  fats  whose  oxidation  may  not  be  complete 
so  that  oxybutyric  and  diacetic  acid  may  appear  in  the  blood.  The 
body  defends  itself  by  calling  upon  the  salts  of  sodium  and  potassium 
and  when  the  margin  of  safety  in  the  salts  is  reached  falls  back  upon 
ammonia.  Carbohydrates  are  rich  in  O  which  aid  in  the  final  oxida- 
tion of  organic  matter  into  CO2  and  water  which  are  easily  eliminated. 

Delayed  chloroform  poisoning  is  largely  a  matter  of  acidosis.  In 
other  days,  we  heard  a  great  deal  about  delayed  shock.  A  few 
years  ago  we  said  there  was  no  such  thing,  that  delayed  shock  was 
either  hemorrhage  or  infection.  Now  we  know  that  the  condition 
described  as  delayed  shock  was  often  acidosis. 

Acidosis  was  formerly  taken  to  mean  that  acetone  bodies  had  been 


ACIDOSIS  201 

found  by  qualitative  tests  in  the  urine,  but  at  the  present  time  it  is 
known  that  the  presence  of  acetone  in  the  urine  is  not  necessarily 
abnormal.  In  other  words,  the  mere  presence  of  acetone  bodies 
does  not  determine  acidosis.  Acidosis  depends  upon  the  relation 
between  acid  production  and  acid  elimination.  The  presence  of 
acid  in  the  urine  may  not  be  expressive  of  an  acidosis,  as  a  serious 
acidosis  may  exist  without  an  abnormal  amount  of  acid  in  the  urine. 

Much  remains  to  be  learned  regarding  acidosis,  and  many  ques- 
tions for  the  present  must  still  be  unanswered,  but  what  little  is 
known  about  this  condition  has  resulted  from  the  study  of  the 
chemistry  of  the  living  body,  which  is  a  very  different  thing  from  the 
chemistry  of  the  body  after  it  has  passed  through  the  process  of 
death.  It  is  useless  to  try  to  solve  the  problem  of  acidosis  in  the 
remains  that  conceal  and  essentially  bury  the  truth.  It  is  note- 
worthy that  autopsy  findings  in  this  condition  are  practically  nil. 
The  pathologist  looks  for  structural  changes,  either  gross  or  micro- 
scopic, but  here  the  alteration  is  in  function  and  not  in  structure. 
Pathology  and  bacteriology  have  been  of  great  help  in  the  study 
of  morbid  conditions,  but  there  is  still  a  very  great  deal  that  is  not 
clear,  and  in  the  medical  advances  of  the  future  chemistry  will 
play  the  stellar  role.  This  will  mean  a  more  careful  study  of  the 
metabolism  of  the  living  patient  opposed  to  study  in  the  dead-house. 

After  this  brief  outline  of  the  subject,  let  us  consider  some  of  the 
methods  used  for  determining  the  degree  of  acidosis.  When  does  a 
patient  suffer  from  acidosis?  Can  we  forecast  it?  Do  we  m.ake  the 
diagnosis  clinically  or  from  laboratory  tests?  How  accurate  are 
these  tests?  How  practical  are  they?  How  do  we  recognize  acido- 
sis? We  suspect  its  presence  from  the  symptoms,  and  confirm  the 
diagnosis  by  laboratory  methods. 

The  chief  evidences  of  acidosis  are  the  unusual  activities  of  the 
body  defenses.  Let  us  take  these  up  in  order  and  consider  the 
means  of  their  recognition  afterward. 

1.  Ammonia  formation  is  increased.  This  is  indicated  by  the 
increased  amount  of  ammonia  excreted  in  the  urine  and  its  relation 
to  the  total  nitrogen.  This  is  the  ammonia  coefficient  and  its 
determination  is  the  oldest  and  most  generally  employed  method  of 
recognizing  acidosis.  As  previously  mentioned,  this  is  not  con- 
clusive. 

2.  Increased  pulmonary  circulation.  The  respirations  are  more 
rapid,  are  deep  and  fuller,  the  lung  spaces  are  dilated  and  the  COa 


202  W.    H.    SMITH   AND   ARTHUR   M.    SHIPLEY 

pressure  is  lower  in  the  blood  than  in  the  alveoli  of  the  lungs.     We 
may  determine  this  by  other  means  than  inspection  of  the  patient. 

3.  Bicarbonate  deficiency  in  the  blood.  This  may  be  demon- 
strated in  a  number  of  ways. 

4.  Reaction  of  the  blood.  In  acidosis,  there  is  a  concentration  of 
H  ions  in  the  blood  and  a  lessening  of  hydroxyl  ions.  The  number 
of  these  combined  is  constant,  and  there  is  a  balance  maintained 
between  them.  As  the  hj^droxyl  ions  are  more  numerous,  the 
reaction  is  alkaline.  When  the  H  ions  increase  above  the  normal, 
there  is  a  diminution  in  the  hydroxyl  ions  and  the  blood  is  less 
alkaline. 

5.  Acetone  bodies  in  the  urine.  Their  presence  is  not  conclusive 
of  acidosis,  but  is  valuable  corroborative  evidence. 

6.  Alkaline  tolerance.  By  this  is  meant  the  estimation  of  the 
amount  of  sodium  bicarbonate  that  can  be  introduced  into  the 
blood  without  changing  the  reaction  of  the  urine. 

Now  let  us  consider  some  of  the  tests  for  determining  the  above 
changes  which  are  evidences  of  lessened  tissue  and  blood  alkalinity 
sometimes  called  acidosis,  and  much  spoken  of  now  as  H  ion  con- 
centration. 

One  of  the  methods  used  for  the  detection  of  acidosis  is  to  esti- 
mate CO2  tension  in  the  alveolar .  air.  Normally  the  tension  is 
about  46  mm.  of  Hg,  which  equals  6  per  cent  of  CO2;  anything 
under  30  mm.  gives  evidence  of  acidosis.  This  method,  while 
useful,  has  as  its  chief  drawback,  difficulty  in  securing  a  representa- 
tive sample  of  air.  Of  the  other  methods,  there  are  the  Von  Slyke 
method  for  measuring  directly  the  sodium  bicarbonate  buffer  in 
the  blood  and  Marriott's  method  for  gauging  the  same  factor  in- 
directly by  determining  hydrogen  ion  concentration  in  a  sample  of 
blood  under  certain  conditions.  Two  other  methods  are  available 
for  detecting  acidosis : 

1.  The  reaction  of  blood  serum  to  phenolphthalein. 

2.  The  effect  of  the  injection  of  sodium  bicarbonate  into  the  blood 
upon  the  reaction  of  the  urine. 

The  details  are  as  follows:  For  the  first  1  cc.  of  serum  is  added  to 
25  cc.  of  absolute  alcohol  and  the  mixture  is  thoroughly  shaken. 
The  precipitated  proteins  are  filtered  off  and  the  alcoholic  filtrate 
without  washing  the  precipitate  is  evaporated  to  drjTiess  with  a  few 
drops  of  phenolphthalein  solution  (avoid  dilution  of  alcohol  from 
steam  while  evaporating).     On  the  earliest  change  from  the  normal, 


ACIDOSIS  203 

the  alcoholic  filtrate  becomes  red,  but  the  residue  loses  its  color 
at  temperature  of  water  bath  in  five  to  fifteen  minutes,  whereas  a 
normal  specimen  retains  its  color  for  hours. 

Sodium  bicarbonate  test  for  the  estimation  of  alkaline  tolerance. 
Five  grams  of  sodium  bicarbonate  are  given  by  mouth  unless  gastro- 
intestinal complications  that  interfere  with  absorption  be  present. 
In  that  case,   intravenous  injection  may  be   used.     The  patient 
should  void  at  time  of  administration  of  bicarbonate.     The  normal 
individual  on  an  ordinary  mixed  diet  reacts  in  about  three  hours  by 
excreting  a  urine  which  is  faintly  acid  or  alkaline.     When  a  speci- 
men does  not  react  sharply  to  litmus  paper,  a  few  cubic  centimeters 
should  be  boiled  in  a  test  tube  to  prevent  change  of  bicarbonate  to  a 
normal  carbonate.     A  specimen  that  should  react  faintly  acid  to 
litmus  before  boiling  reacts  alkaline  after  boiling.     In  cases  that 
do  not  react  the  bicarbonate  may  be  given  in  increasing  quantities, 
e.g.,  20  to  30  grams  at  thirty-six  hour  intervals,  and  in  some  cases 
mass  ve  doses  have  been  given  without  effecting  the  reaction  of  the 
urine,  e.g.,  150  grams  in  one  to  two  days.     (The  bicarbonate  test,  of 
course,  would  be  of  no  use  in  those  patholog"cal  conditions  that 
cause  alkaline  urine.)     It  is  possible  in  a  general  way  to  determine 
the  physiologic  effect  of  various  grades  of  depletion  in  the  bicarbon- 
ates,  and  deficit  of  as  much  as  20  grams  can  be  detected  by  blood 
examination,  but  does  not  give  rise  to  symptoms.     A  deficit  of  40 
grams  causes  a  sharp  change  in  the  behavior  of  the  blood,  but  still 
does  not  produce  symptoms.     A  deficit  of  70  to  80  grams  causes 
dyspnoea.     It  is  dijSficult  to  determine  even  approximately  quanti- 
ties which  would  cause  the  more  advanced  symptoms  of  stupor  and 
coma,  since  other  factors  contribute  to  the  production  of  these 
symptoms.     In  two  reported  cases,  a  condition  of  air  hunger  and 
partial  coma  was  relieved  temporarily  by  injection  of  130  to  160 
grains  respectively  of  sodium  bicarbonate.     Four  per  cent  if  in- 
jected subcutaneously  and  2  per  cent  if  injected  intravenously. 
It  is  also  to  be  noticed  that  the  presence  of  a  slight  grade  of  relative 
acidity,  although  it  may  not  give  rise  to  prominent  dyspnoea,  limits 
the  reserve,  so  that  any  influence  such  as  exercise,  holding  the  breath, 
etc.,  which  is  followed  by  increased  ventilation  in  normal  subjects, 
acts,  in  these  subjects,  with  exaggerated  effect.     The  field  of  re- 
spiratory response  is  strictly  limited  and  its  limits  in  these  people 
are  easily  crossed. 
Symptoms.    Acidosis,  while  known  to  occur  without  any  disease 


204  W.    H.    SMITH    AND    ARTHUR   M.    SHIPLEY 

being  detected  to  which  the  acidosis  could  be  referred,  is  more 
commonly  found  to  be  associated  in  the  course  of  other  morbid  con- 
ditions. The  diseases  in  which  one  frequently  finds  evidence  of 
acidosis  are:  Cardio-vascular,  renal,  cerebral  arterio-sclerosis,  em- 
physema, the  more  severe  diarrhea  of  infants,  and  as  a  post-operative 
complication  of  surgical  work. 

The  symptomatology  of  acidosis  depends  largely  on  the  underly- 
ing conditions,  but  the  clinical  evidence  that  should  direct  our  at- 
tention to  this  condition  is  hyperpnoea,  and  hyperpnoea  without 
equivalent  cyanosis  is  our  first  guide.  In  the  more  serious  cases, 
there  is  no  reserve,  the  breath  can  not  be  held  and  forced  breathing 
is  followed  by  no  period  of  apnoea. 

Oxygen  affords  little  or  no  relief,  although  it  alters  the  type  of 
breathing.  The  hyperpnoea  is  usually  more  severe  toward  evening 
and  is  frequently  of  the  type  known  as  Cheyne-Stokes.  In  an 
elderly  subject,  hurried  breathing  with  or  without  cyanosis  is  al- 
ways suspicious  of  acidosis.  In  diarrhea  of  children,  one  striking 
symptom  of  severe  acidosis  is  a  dimunition  in  urinary  output; 
anuria  is  by  no  means  unusual.  To  sum  up,  we  may  have  as  a 
general  maxim  that  hyperpnoea  indicates  acidosis  and  that  acidosis 
indicates  alkali  therapy. 

It  will  possilDly  be  well  to  consider  one  clinical  symptom  that  is 
strikingly  present  in  acidosis.  This  symptom  is  dyspnoea,  more 
properly  hyperpnoea.  Dyspnoea  should  always  make  one  suspect 
acidosis  and  especially  if  unaccompanied  by  cyanosis.  In  an  elderly 
patient  with  dyspnoea,  with  or  without  cyanosis,  acidosis  should 
always  be  given  foremost  consideration.  How  are  we  to  explain 
dyspnoea?  It  was  previously  mentioned  that  in  acidosis  there  was  a 
depletion  of  buffer  substances  in  the  blood  and  body  fluids.  The 
primary  effect  of  reduction  is  a  diminution  in  the  capacity  of  the 
blood  to  transport  acids  or  alkalies.  The  acid  most  abundantly 
produced  in  the  body  is  carbonic  acid  and  when  the  buffer  sub- 
stances are  reduced,  the  capacity  of  the  blood  for  carrying  carbonic 
acid  is  reduced.  This  brings  about  an  accumulation  of  CO2  in  the 
tissues,  and  among  other  tissues  the  respiratory  center.  It  is  well 
known  that  any  increase  in  acidity  in  the  respiratory  center  serves 
as  a  stimulant  to  this  center,  and  as  a  result,  the  rate  and  amplitude 
of  the  respirations  are  increased.  Crile  says  that  the  same  con- 
dition stimulates  the  formation  of  adrenin  and  that  this  agent 
causes  a  dilatation  of  the  alae  nasi,  the  bronchi,  and  the  alveoli. 


ACIDOSIS  205 

In  health,  the  tension  oC  CO2  in  the  arterial  blood  and  the  alveoli  is 
the  same.  In  acidosis,  the  tension  is  lower  in  the  blood  than  in  the 
alveoli.  This  is  because  there  are  less  alkalies  to  carry  CO2  from 
tissues  to  lungs  and  because  the  alveolar  air  is  more  abundant, 
thereby  diluting  the  CO2. 

Treatment.  The  treatment  of  this  condition  presents  no  especial 
difficulties,  and  in  the  majority  of  cases  it  offers  a  good  promise  of 
success  if  the  condition  be  not  too  far  advanced.  This  is  especially 
true  of  hydroxyl  ion  concentration  complicating  surgical  practice. 
In  the  City  Hospitals  at  Bay  View  we  have  been  interested  in  the 
prevention  of  acidosis.  Many  of  the  patients  there  are  poor  surgical 
risks,  they  are  often  old,  many  are  alcoholics,  and  their  nutrition  is 
below  par.  When  subjected  to  general  anaesthesia,  and  operation, 
many  require  a  large  quantity  of  ether  as  a  result  of  the  alcoholic 
habit.  Because  of  this  combination,  the  factors  that  may  lead  to 
acidosis  are  often  present,  and  we  noticed  symptoms  of  mild  acidosis 
in  many  of  them,  persistent  vomiting,  restlessness,  hurried  respira- 
tion, and  some  fever.  In  a  series  of  cases,  extending  over  six  months, 
all  operative  cases  were  subjected  to  the  following  post-operative 
treatment.  At  the  end  of  the  anaesthetic,  the  stomach  was  washed 
and  250  cc.  of  2  per  cent  bicarbonate  of  soda  w^as  put  in  the  stomach 
and  left  there.  The  patient  was  given  sodium  bicarbonate  by  mouth 
and  glucose  5  per  cent  was  given  by  proctoclysis.  This  routine 
treatment  produced  a  marked  change  in  the  post-operative  hehavior. 
In  the  absence  of  other  complications  there  was  practically  no  vomit- 
ing, and  the  tendency  to  restlessness  and  hurried  breathing  was 
very  much  less  noticeable. 

If  the  patient  for  any  reason  has  been  starved,  we  have  recently 
been  giving  500  cc.  of  2  per  cent  sodium  bicarbonate  solution  intra- 
venously during  the  operation. 

There  are  several  interesting  points  in  the  treatment  of  this 
condition  that  should  not  be  overlooked.  Sometimes  a  combina- 
tion of  calcium  and  sodium  bicarbonate  gives  better  results  than 
sodium  bicarbonate  alone. 

If  bleeding  is  to  be  resorted  to,  care  should  be  taken  not  to  reduce 
the  quantity  of  blood  without  introducing  a  like  or  greater  quantity 
of  either  sodium  chloride  or  sodium  bicarbonate  solution.  Care 
must  be  taken  not  to  introduce  sodium  carbonate  into  the  cellular 
tissues  as  it  will  often  produce  a  slough.  Sodium  bicarbonate  may 
be  given  subcutaneously.     Sodium  bicarbonate  when  given  in  large 


206  HUGH    BRENT 

doses  by  mouth  may  cause  nausea  and  vomiting.  This  can  he 
prevented  by  dissolving  the  powder  in  just  enough  water  to  hold  it 
in  solution  and  diluting  it  with  carbonated  water  (Underhill). 

Glucose  when  given  by  rectum  is  irritating  and  care  should  be 
taken  to  alternate  the  proctoclyses  with  periods  of  rest.  A  good 
method  is  to  give  a  solution  containing  2  per  cent  sodium  bicarbonate 
and  5  per  cent  glucose  by  rectal  injection  for  four  hour  periods 
alternating  with  four  hours  of  rest. 

In  addition  to  the  above  methods,  which  are  chiefly  directed 
toward  the  establishment  of  normal  blood  alkalinity,  the  lung  and 
kidney  excretions  should  be  carefully  watched.  Usuall}',  the  lung 
excretion  will  take  care  of  itself.  COa  saturation  is  the  best  re- 
spiratory stimulant  and  in  this  condition  acts  as  such. 

The  kidney  function  is  not  so  capable  of  looking  after  itself.  It 
must  be  watched.  There  are  a  number  of  agents  that  are  useful 
here.  In  our  experience  we  have  gotten  best  results  from  fluids 
and  sparteine  sulphate.  Fluid  may  be  given  by  mouth,  by  rectum, 
by  hypodermoclysis  or  intravenously,  as  sugar  solution,  sodium 
bicarbonate  solution  or  sodium  chloride  solution.  We  believe  we 
have  seen  a  very  satisfactory  response  from  the  hyperdermic  use  of 
large  doses  of  sparteine  sulphate.  We  give  two  doses  of  2  grains 
each  at  two  hour  intervals. 

BLOOD  TRANSFUSION  IN  EXTRAUTERINE  GESTATION^ 

By  Hugh  Brent,  M.D.,  F.A.C.S. 
Baltimore,  Maryland 

Intraperitoneal  hemorrhage  is  the  most  frequent  complication 
associated  with  extrauterine  pregnancy.  It  is  true  of  course  that 
in  the  exceptional  case  simple  death  of  the  foetus  from  trophic 
disturbances  occurs,  but  in  nearly  every  instance  there  is  an  ac- 
companjdng  hemorrhage  of  greater  or  less  magnitude. 

The  blood  lost  varies  from  an  insignificant  amount  to  a  quantity 
sufficient  to  produce  the  death  of  the  individual.  These  tragic 
cases  constitute  a  rather  small  percentage,  but  when  they  do  present 
themselves  the  gynecologist  faces  one  of  the  most  serious  crises  in 
the  field  of  abdominal  surgery. 

1  From  the  gynecological  department  of  the  University  of  Maryland  and 
College  of  Physicians  and  Surgeons. 


BLOOD    TRANSFUSION    IN    EXTRAUTERINE    GESTATION  207 

The  indication  for  ligation  of  the  bleeding  vessels  is  absolute  and 
any  avoidable  delay  in  the  procedure  is  inexcusable. 

Years  ago  it  is  true  the  case  in  articulo  mortis  was  probably  offered 
a  more  reasonable  chance  for  recovery  through  a  nerve-racking 
wait  for  reaction  from  the  primary  shock.  In  some  of  these  cases, 
rapid  and  prompt  attempts  to  aid  nature  through  cardio-vascular 
stimulation  finally  succeeded  in  'producing  a  fatal  continuance  of  the 
hemorrhage. 

That  some  of  them  did  show  immediate  and  permanent  improve- 
ment is  no  argument  in  favor  of  such  management — we  are  all 
familiar  with  the  case  that  recovers  amjhow. 

In  "ectopic  hemorrhage/'  nature  plugs  the  gaping  vessels  with 
delicate,  easily  expelled  clots,  vascular  tension  is  automatically 
lowered  by  the  decrease  in  volume  of  blood  and  the  bleeding  almost 
always  ceases  short  of  a  lethal  termination.  To  allow  a  failing 
pulse  to  obscure  or  blot  out  from  one's  mind  the  intra-pelvic  picture 
may  lead  to  illogical  therapy  and  the  most  disastrous  consequences. 

Some  die,  it  is  true,  even  before  the  simple  and  efficacious  devices 
of  nature  can  be  brought  into  play,  but  they  certainly  represent 
cases  in  which  ill-advised  stimulation  could  only  serve  to  hasten 
the  process.  Rest,  morphia,  ice  to  the  abdomen,  and  oxygen  when 
indicated,  will  save  all  the  cases  that  m.ay  be  saved  while  preparation 
for  the  permanent  sealing  of  the  vessels  by  ligature  is  in  progress. 

Needless  to  say  operation  should  wherever  possible  be  under- 
taken in  a  modern,  well  equipped  hospital.  It  would  be  difficult  to 
conceive  a  situation  in  which  blood  transfusion  at  the  proper  mo- 
ment is  more  clearly  or  urgently  indicated.  To  see  the  dying  victim 
of  this  frightful  lesion  steadily  improve  as  the  operation  progresses, 
to  close  the  abdomen  with  shock  abating  and  the  blush  of  life  creep- 
ing into  the  pallid  face  makes  one  forever  grateful  that  we  have  at 
our  disposal  the  one  resource  that  the  situation  so  patently  cries 
out  for. 

The  proper  time  for  transfusion  is  at  the  time  of  operation,  following 
out  the  principle  of  no  stimulation  until  the  source  of  hemorrhage  is 
accessible. 

Preparation  for  abdominal  section  having  been  completed,  the 
surgeon  opens  the  abdomen  as  the  first  few  hundred  cubic  centi- 
meters of  blood  enter  the  circulation. 

During  the  past  fourteen  months  I  have  had  referred  to  me 
twelve  cases  of  tubal  pregnancy.     Two  patients  in  this  series  were 


208  HUGH    BRENT 

to  all  appearances  dying  of  hemorrhage  on  admission  to  the  hos- 
pital and  were  operated  on  immediately  with  coincident  blood  trans- 
fusion. 

The  transfusion  in  each  instance  was  performed  by  Dr.  Charles 
Bagley,  Jr.,  with  the  Kimpton-Brown  tube. 

While  these  cases  exhibit  nothing  unique,  I  feel  that  they  are 
worthy  of  report  as  examples  of  the  very  happy  result  to  be  ob- 
tained by  this  method  of  treatment. 

A.  H.,  age  38,  multipara.  Mercy  Hospital  10838.  Admitted 
August  28,  1916.     Referred  by  Dr.  George  Settle. 

Patient  has  one  child  living  six  years  old.  Miscarriages  at  six 
weeks,  two  and  one-half  and  four  years  ago.  Last  regular  men- 
strual period,  which  was  normal,  occurred  on  June  28.  Period  in 
July  missed.  On  August  28  patient  was  seized  with  a  sudden  violent 
pain  in  the  lower  abdomen,  during  which  she  fainted.  This  was 
followed  by  collapse  with  thirst  and  giddiness. 

On  admission  to  the  hospital  was  in  profound  shock  with  extreme 
pallor,  air  hunger  and  an  almost  imperceptible  pulse.  The  abdomen 
was  distended  and  tender  with  a  flat  percussion  note  in  the  flanks. 
The  pelvis  filled  with  a  fluctuant  mass  distending  the  cul  de  sac  of 
Douglas. 

Diagnosis.  Ruptured  extrauterine  pregnancy  with  massive  hem- 
orrhage. 

Operation.  Transfusion.  Left  salpingectomy.  Estimated  blood 
in  abdomen  1500  cc.+  Donor,  who  gave  750  cc,  was  patient's 
niece.     Uninterrupted  recovery.     Discharged  September  18,  1916. 

A.  M.,  age  33,  I  Para.  University  Hospital  4980.  Admitted 
February  5,  1917.     Referred  by  Dr.  G.  C.  Lockard. 

Patient  has  one  child  three  and  a  half  years  old.  On  December  14, 
1916,  patient  had  her  regular  menstrual  period,  which  was  normal. 
Two  weeks  later  began  to  bleed  irregularly  from  the  uterus;  this 
hemorrhage  was  unaccompanied  by  pain  and  lasted  for  two  weeks. 
On  January  14,  1917,  had  a  sudden  violent  attack  of  pain  in  the 
lower  abdomen  with  vomiting,  fainting  and  pallor.  The  pain 
persisted  in  a  modified  degree  for  two  days.  Remained  in  bed  for 
two  weeks  and  gradually  improved,  though  she  continued  to  feel 
that  ''something  was  wrong  in  her  abdomen."  Patient  did  not 
menstruate.  On  February  5,  1917,  had  an  attack  similar  to  the 
one  of  January  14th.     She  vomited  and  fainted  as  before. 

I  was  called  to  see  her  in  consultation  by  Dr.  Lockard,  who  saw 
her  for  the  first  time  on  admission  to  the  hospital. 


DELIRIUM   TREMENS  200 

She  was  apparently  in  extremis,  restless,  pallid,  features  pinched 
and  a  weak,  thready  pulse  of  160.  Abdomen  not  rigid,  but  dis- 
tended and  generally  tender.  Pelvis  filled  with  a  soft,  fluctuant 
mass,  bulging  and  excessive  tenderness  in  the  cul  de  sac  of  Douglas. 
Cervix  movable  and  lateral  vaginal  fornices  not  infiltrated. 

Diagnosis.  Ruptured  extrauterine  pregnancy  with  massive  hem- 
orrhage. 

Operation.  Transfusion,  right  salpingo-oophorectomy,  left  salpin- 
gectomy. Estimated  blood  in  abdomen  1500  cc.  The  left  tube  was 
ruptured  and  there  was  a  secondary  chorionic  implantation  on  the 
posterior  surface  of  the  right  broad  ligament.  Hemorrhage  from 
this  area  necessitated  removal  of  the  right  tube  and  ovary. 

Donor:  Husband,  who  gave  750  cc.  Patient  made  an  uninter- 
rupted recovery,  and  was  discharged  February  27,  1917. 

2124  Maryland  Avenue. 

DELIRIUM  TREMENS  AS  A  COMPLICATION  OF  SURGICAL 
LESIONS.  SOME  EXPERIENCES  WITH  A  SIMPLE 
METHOD  FOR  ITS  PREVENTION  AND  CURE^ 

By  Ignatius  P.  A.  Byrne,  M.D. 

Mercy  Hospital,  Baltimore,  Maryland 

Surgical  cases  complicated  with  delirium  tremens  and  their  treat- 
ment have  afforded  us  an  interesting  study.  During  the  past  eight 
months  service  in  Mercy  Hospital  we  have  been  able  to  obtain  most 
excellent  results  by  a  simple  modification  of  the  Lambert  method, 
depending  largely  on  free  purgation  in  cases  where  we  suspected 
from  the  previous  history,  and  condition  at  time  of  examination, 
that  our  patient  would  develop  delirium  tremens  if  not  given  active 
preventive  treatment. 

Delirium  tremens  as  you  well  know  is  an  acute  manifestation  of 
chronic  alcoholism.  The  essential  mental  symptoms  of  this  con- 
dition are  disturbances  of  consciousness,  disorientation,  partial  or 
complete,  and  fantastic  visual  and  auditory  hallucinations — ^the 
former  predominating. 

The  occurrence  of  delirium  tremens  does  not  run  parallel  to  the 
amount   of   alcohol   taken — ^idiosyncrasy    playing   a   part.     Many 

^  Read  before  Mercy  Hospital  House  Staff  Medical  Society. 


210  IGNATIUS    P.    E.    BYRNE 

men  who  have  never  been  intoxicated,  but  who  for  years  have 
steadily  taken  alcohol,  will  after  some  severe  accident  develop  delirium 
tremens. 

The  truth  of  this  statement  was  demonstrated  to  us  recently  in 
our  single  fatal  case,  one  in  which  the  patient  was  brought  to  us 
with  severe  lacerations  dividing  several  tendous  about  his  wrist. 

His  history  and  general  appearance  threw  us  off  from  suspecting 
that  delirium  tremens  would  follow  his  injiu-y  and  thus  he  was 
not  given  our  usual  form  of  treatment.  The  second  day  after  his 
admittance,  however,  he  had  hallucinations  and  became  very  restless, 
tearing  off  his  bandages  and  infecting  his  wounds. 

He  was  then  given  active  purgation,  which  somewhat  checked  his 
delirium  but  unfortunately  his  infection  had  become  extensive  and 
he  died  of  septicaemia  within  one  week  after  operation. 

We  have  noted  that  traumatism,  such  as  fracture  of  ribs,  legs, 
arms  and  skull,  very  frequently  causes  an  outbreak  of  delirium 
tremens.  Therefore  the  surgeon  must  be  on  the  watch  for  such 
exigencies  and  devise  means  whereby  his  surgical  skill  will  not  be 
wasted  through  his  patient  developing  delirium  tremens.  It  is 
well  known  that  such  patients  do  badly,  no  matter  how  skillful  the 
surgeon  may  be  at  time  of  operation. 

My  object  in  presenting  this  paper  before  this  meeting  is  to  cite 
our  experiences  and  treatment  with  suspected  cases,  in  the  hope 
that  it  may  prove  of  interest  and  benefit  to  our  fellow  surgeons, 
who  may  have  used  a  more  complicated  method  of  treatment. 

One  of  the  first  cases  that  came  under  my  care,  last  June,  was  a 
man  who  had  received  severe  lacerations  about  the  head  and  face 
during  a  drunken  brawl.  My  natural  impulse  was  to  satisfy  his 
cravings  for  whisky  by  small  doses  twice  or  three  times  a  day  and 
gradually  lessen  the  amount  until  he  was  able  to  stand  complete 
withdrawal.  However  I  found  that  by  following  Dr.  McGlannan's 
edict  of  no  whiskey  but  active  and  free  purgation  all  purposes  were 
answered  and  the  patient  brought  through  much  more  quickly 
and  with  most  satisfactory  results. 

The  treatment  that  we  have  been  using  consists  of  free  purgation, 
and  when  necessary  Tine.  Nux  Vomica  and  Tine.  Hyoscyamus  in  small 
doses.  It  is  a  somewhat  modified  Lambert  treatment,  and  to  my  mind 
from  observations  here  in  Mercy  Hospital  and  in  a  sanatorium  with 
which  I  was  formerly  connected  and  in  which  latter  the  entire 
Lambert    treatment    was    employed — the    simple    and    continued 


DELIRIUM   TREMENS  211 

purgation  is  the  truly  active  agent  in  the  cure  rather  than  the  drugs 
accompanying  it. 

The  treatment  is  extremely  simple.  When  a  case  is  admitted  to 
our  service,  in  which  we  believe,  from  the  past  history  and  present 
condition  the  patient  is  likely  to  develop  delirium  tremens  if  left 
untreated,  the  following  method  is  employed.  He  is  given  magnesium 
sulphate  §ii  and  compound  carthartic  pills  No.  VI.  q.  p.  m.  and 
this  treatment  continued  until  his  stools  are  green  in  color,  due  to  the 
presence  of  bile  unchanged  in  its  passage  through  the  bowel. 

The  patient  is  now  given  a  day  or  two  of  freedom  from  purgation 
and  light  doses  again  instituted  if  necessary.  His  diet  during  all 
this  time  is  free — meats  being  excluded.  In  our  wards  regular  diet 
is  ordered. 

The  principle  underlying  this  treatment,  according  to  the  views 
of  E.  Meyer,  Gauser,  Fiehm  and  others,  is  that  alcoholic  abuse  renders 
the  gastrointestinal  tract  and  liver  incapable  of  destroying  toxins 
and  renders  them  susceptible  to  pathogenic  organism.s,  with  the 
result  that  the  poisons  accumulate  and  at  a  given  time  overwhelm 
the  individual. 

In  our  series  of  cases — ten  in  past  eight  months — ^four  developed 
delirium  tremens  lasting  from  a  day  to  three  days,  two  cases  (of  the 
four)  becoming  so  noisy  as  to  require  removal  from  ward  temporarily. 
The  treatment  however  in  all  ten  cases  was  the  same:  no  whiskey 
being  given.  Tr.  Nux  Vomica  and  Tr.  Hyoscyamus  in  doses  of  10 
drops  each  q.  three  hours  was  given  and  Paraldehyde  3i  to  3ii  given 
to  induce  sleep. 

Of  the  four  cases  which  developed  dehrium  tremens  the  first  (Case 
No.  806  (1917)  admitted  October  7,  1916,  discharged  November  14) 
was  but  one  day  in  this  condition.  He  had  been  a  heavy  drinker  all 
his  life — often  taking  as  much  as  40  drinks  of  whiskey  a  day — to 
suddenly  shut  off  whiskey  in  his  case  seemed  risky  but  he  responded 
to  treatment  well  and,  but  for  one  day  in  which  his  mind  was  un- 
balanced, he  made  an  uneventful  recovery  from  several  severe 
wounds  about  face  and  head. 

In  his  case  we  did  a  lumbar  puncture  the  day  following  his  out- 
break of  delirium  but  found  little  change  resulting  therefrom. 

I  might  state  here  that  but  little  work  as  regards  treatment  by 
lumbar  puncture  to  relieve  dehrium  tremens  has  been  done.  White 
says  that  lumbar  puncture  may  be  useful  to  diagnosticate  a  serous 
from  a  purulent  meningitis  but  does  not  give  permanent  relief  from 
symptoms. 


212  IGNATIUS    P.    A.    BYRNE 

Dr.  Gillis,  the  neurologist  to  the  Mercy  Hospital,  believes  much 
good  may  be  obtained  in  the  use  of  lumbar  puncture,  the  fluid  drawn 
off  being  under  considerable  pressure.  He  suggests  that  the  spinal 
fluid  be  withdrawn  and  a  like  amount  of  sterile  salt  solution  in- 
jected to  equalize  pressure. 

The  second  case  (Case  No.  12189  (1916)  admitted  November  24, 
1916,  discharged  December  12,  1916)  was  mentally  unbalanced  for 
about  two  days  but  not  sufficiently  troublesome  to  warrant  his  re- 
moval from  ward.  He  was  operated  upon  for  double  hernia  and  was 
not  given  the  purgation  treatment,  as  he  gave  us  a  misleading  his- 
tory. When  active  treatment  was  instituted  his  condition  rapidly 
improved  and  when  discharged  was  entirely  well. 

The  third  case  developing  delirium  tremens  was  (Case  No.  641 
(1917)  admitted  January  27, 1917  and  discharged  February  20, 1917). 
This  was  the  most  severe  case,  the  patient  having  to  be  removed 
from  ward  for  three  days. 

He  was  admitted  with  a  Pott's  fracture  and  on  questioning  him 
as  to  his  habits  denied  drinking  at  all.  Later  we  learned  from  his 
wife,  after  his  delirium  had  subsided,  that  he  was  rarely  sober,  so 
that  we  lost  several  'days  after  his  admittance  in  instituting  our 
purgation  treatment. 

However  we  gave  him  active  treatment  when  first  symptoms  were 
noted  and  continued  it  throughout  his  delirium.  On  the  third 
day  he  was  brought  back  to  ward  and  later  to  operating  room  for 
application  of  cast.  He  is  entirely  well  of  his  delirium  and  is  now 
recovering  from  his  fracture. 

The  last  case  we  had  in  which  delirium  developed  was  (Case  No. 
509  (1917)  admitted  February  2,  1917,  died  February  12,  1917).  He 
was  admitted  with  a  cut  wrist,  tendons  and  vessels  being  entirely  cut 
across.  He  was  at  once  brought  to  the  operating  room,  the  tendons 
sutured  and  vessels  tied.  It  was  noted  at  the  time  of  the  operation 
that  but  a  small  amount  of  ether  was  used  to  anaesthetise  him  in 
contradistinction  to  what  is  normally  used  for  an  alcoholic — he 
further  stated  that  he  was  not  a  drinking  man  and  so  he  was  not 
given  an  active  purgation. 

About  the  third  day  after  admission  he  showed  symptoms  of 
delirium,  talking  irrationalty,  etc.,  tearing  off  his  dressings  and 
getting  his  wound  badly  infected.  A  general  septicemia  resulted, 
of  which  he  died — ^ten  days  after  his  admittance  to  hospital. 

We  feel  we  could  have  headed  off  his  delirium  had   we  begun 


DELIRIUM   TREMENS  213 

active  purgation  at  once;  we  were  deceived  as  to  his  past  history 
and  so  our  treatment  was  begun  too  late. 

The  other  six  cases  which  we  treated  were :  Case  No.  12012  (1916) 
admitted  November  12,  1916,  and  discharged  December  28,  1916. 
This  patient  came  in  suffering  from  a  fractured  leg  and  brought 
with  him  aU  the  earmarks  of  a  likely  delirium.  The  treatment  as 
outlined  saved  him. 

Case  No.  401  (1917)  admitted  October  28,  1916,  discharged 
February  1,  1917;  came  in  with  a  fractured  leg  which  he  received 
while  on  a  drunken  spree.  His  treatment,  as  you  may  surmise, 
was  most  active  and  liis  possible  deliriimi  never  appeared. 

Case  No.  489  (1917)  admitted  November  21,  1916,  discharged 
February  8,  1917.  Broke  the  head  of  his  femur  by  falling  over  the 
banister  wliile  on  a  spree.  He  was  leading  right  for  a  fine  case  of 
delirium  tremens  but  fortunately  was  checked  and  had  an  unevent- 
ful recover3^ 

"J.H."  admitted  February  17,  1917,  is  still  in  house  and  now  under 
Dr.  Baggott's  care  for  erysipelas.  He  came  to  us  with  a  fractured  hu- 
merus and  showed  mental  symptoms  of  an  impending  delirium.  His 
treatment  was  as  outlined  and  up  to  time  of  transfer  to  Dr.  Baggott 
had  not  developed  a  delirium. 

Case  No.  521  (1917)  admitted  February  3,  1917,  with  frost-bitten 
fingers,  and  most  convincing  history,  was  given  preventive  treatment 
and  was  discharged  OK. 

Case  No.  759  (1917)  admitted  February  10,  1917,  and  discharged 
March  1,  1917,  with  extensive  scalp  laceration.  Treated  as  above. 
No  complications. 

The  question  of  "wet  brain"  comes  up  for  consideration  in  the 
treatment  of  delirium  tremens  but  as  yet  there  has  been  nothing 
very  satisfactory  learned  as  to  its  significance.  "Stillman,"  who 
has  made  a  study  of  this  condition,  says  that  the  fluid  in  the 
pial  oedema  is  not  per  se  an  oedema  of  the  pathological  process 
but  in  every  instance  represents  the  reciprocal  of  brain  shrinkage. 

In  conclusion  I  would  say  that  while  our  series  has  but  ten  cases 
it  represents  only  cases  with  traumatic  lesions  and  according  to  the 
literature  may  be  considered  a  fair  percentage.  In  a  series  of  1106 
cases  reported  from  the  Cook  County  Hospital,  Chicago  (Amer. 
Jour.  Med.  Science,  1911,  cxli,  673,  considering  delirium  tremens 
from  all  sources,  but  68  were  of  traumatic  origin. 


214  HOSPITAL   APPOINTMENTS 

THE  CHAMPERS  MEMORIAL  FUND 

Last  Notice — The  Fund  will  be  Closed  April  10,  1917 

The  Alumni  Association  of  the  College  of  Physicians  and  Surgeons, 
has  undertaken  the  collection  of  a  fund  for  the  purpose  of  provid- 
ing a  portrait  and  memorial  of  Dr.  J.  W.  Chambers. 

The  letter  printed  below  has  been  sent  to  the  members  of  the 
P.  &  S.  Alumni.  The  committee  will  be  glad  to  have  a  contribution 
from  any  friend  of  Dr.  Chambers  who  has  not   received  the  letter. 

The  list  will  remain  open  until  April  10,  1917.  All  who  desire  to 
contribute  must  do  so  before  that  date. 

The  undersigned  committee  has  been  appointed  by  the  Alumni  Associa- 
tion to  collect  a  fund  for  the  purpose  of  providing  a  portrait  and  memo- 
rial of  Dr.  J.  W.  Chambers,  who  died,  January  21,  1917. 

Dr.  Chambers  was  graduated  from  the  College  of  Physicians  and  Sur- 
geons in  1878,  and  has  served  continuously  in  various  capacities  ever 
since.  During  these  thirty-nine  years  he  endeared  himself  to  successive 
classes,  and  became  one  of  the  most  distinguished  of  our  alumni. 

We  hope  that  the  prompt  and  generous  response  to  this  appeal,  made 
to  his  friends  and  colleagues,  fellow  alumni  and  former  students,  will  in- 
dicate his  deserved  popularity. 

Please  send  your  contribution  to  Dr.  C.  E.  Brack,  Calvert  and  Sara- 
toga Streets,  Baltimore,  who  will  act  as  treasurer  for  the  fund. 

Alexius  McGlannan,  Chairman, 

W.  J.  Todd, 

C.  E.  Brack, 

Harry  Friedenwald, 

W.  R.  McKenzie, 

Standish  McCleary. 

HOSPITAL  APPOINTMENTS 

university  hospital 

This  hospital  has  adopted  a  new  system  of  appointments  for  house 
officers,  in  order  to  comply  with  the  Pennsylavnia  requirements. 
Hereafter  there  wll  be  senior  and  junior  internes.  The  senior 
internes  will  remain  the  whole  year  attached  to  the  service  to  which 
they  are  appointed,  but  the  juniors  wiW  rotate  every  4  months 
between  medicine,  surgery  and  obstetrics.  It  may  be  a  matter  of 
opinion  whether  this  is  the  best  arrangement  or  not  but  if  our  men 
desire  to  practice  in  Pennsylvania  they  must  have  had  a  rotating 


BALTIMORE    MEDICAL    COLLEGE    ALUMNI    CERTIFICATE  215 

service.  In  accordance  with  this  provision  the  following  appoint- 
ments have  been  made: 

Senior-  Internes:  John  E.  Evans,  A.B.,  M.D.,  South  Carolina; 
Dorsey  P.  Etzler,  M.D.,  Maryland;  Frank  C.  Marino,  M.D.,  Mary- 
land. 

Junior  Internes:  Juliuo  R.  Rolenson,  M.D.,  Porto  Rico;  Fred  F. 
Armstrong,  Connecticut;  Robert  S.  G.  Welch,  Maryland;  DaCosta 
Bennett,  A.B.,  Maine;  Howard  L.  Wheeler,  Maryland;  John  T. 
Davis,  Virginia;  Erland  H.  Hedrick,  West  Virginia;  James  Holmes, 
Massachusetts ;  Allan  W.  MacQreegor,  Connecticut;  W.  E.  Maddison, 
Utah;  Elbert  C.  Reitzel,  North  Carolina;  Leo  L.  Smith,  Oklahoma; 
Joseph  Salan,  Indiana; 

MARYLAND    GENERAL    HOSPITAL 

Seniors:  G.  A.  Bawden,  M.D.,  Maryland;  B.  H.  Growt,  M.D., 
Maiyland;  B.  M.  Jaffe,  M.D.,  Maryland;  I.  B.  Brounshas,  New  York. 

Juniors:  F.  H.  Clark,  Georgia;  Luis  J.  Fernandez,  Porto  Rico; 
F.  H.  Machin,  Maryland;  H.  L.  Shinn;  K.  C.  Thomas,  North 
Carolina;  C.  0.  Wolf,  A.B.,  North  CaroHna;  R.  A.  Wolford,  West 
Virginia;  C.  F.  Worrell,  Virginia. 

MERCY    HOSPITAL 

Dr.  G.  R.  Post;  Dr.  W.  K.  Mackenzie;  Dr.  Thos.  K.  Galvin; 
Dr.  Peterson;  Dr.  Kearney;  Dr.  Lawson;  G.  H.  Bloom,  New  Jersey; 
L.  H.  Bloom,  New  Jersey;  H.  R.  Carroll,  Maryland;  F.  C.  Eleder, 
Maryland;  F.  C.  Hertzog,  Pennsylvania;  H.  C.  Holm,  Denmark; 
L.  A.  M.  Krause,  Maryland;  L.  A.  Lasher,  Pennsylvania;  C.  C.  Nohe, 
West  Virginia;  H.  W.  Wheaton,  New  York;  C.  R.  Thomas,  A.B., 
Maryland. 

THE    BALTIMORE    MEDICAL    COLLEGE    ALUMNI 
CERTIFICATE 

The  frontispiece  of  the  present  issue  may  call  for  a  word  of  ex- 
planation. 

Following  the  appearance  in  the  November  issue  of  a  statement 
to  the  effect  that  the  certificates  issued  by  the  University  of  Mary- 
land to  the  graduates  of  the  Baltimore  Medical  College  may  still 
be  had  for  ten  dollars  by  applying  to  the  Registrar,  a  large  number 


216  BALTIMORE   MEDICAL    COLLEGE    ALUMNI    CERTIFICATE 

of  inquiries  were  received  regarding  the  nature  and  appearance  of 
the  certificate.  The  frequency  of  these  inquiries  has  convinced 
us  that  this  is  a  matter  of  such  hvely  interest  to  a  considerable 
portion  of  our  alumni  that  a  facsimile  of  one  of  the  certificates  would 
make  an  appropriate  frontispiece. 

For  the  benefit  of  our  readers  whose  Latin  is  rusty,  we  append 
the  following  translation: 

UNIVERSITY  OF  MARYLAND 

To  All  to  Whom  These  Presents  Mat  Comb 

GREETING 

Whebeas  James  M,  H.  Rowland,  a  man  of  learning  and  skilled  in  medicine, 
on  the  twenty-third  day  of  March  in  the  year  1892  received  from  the  Baltimore 
Medical  College  the  degree  of  Doctor  of  Medicine: 

And  whereas  the  said  College  in  the  year  191.3  was  united  and  consolidated 
with  the  University  of  Maryland  and  no  longer  is  known  b}^  the  said  title  : 

Therefore  he  it  known  to  all  that  James  M.  H.  Rowland  on  account  of  the 
said  consolidation  by  the  decree  and  pronouncement  of  the  Regents  of  the 
University  of  Maryland  has  been  declared  to  possess  in  this  University  all 
the  honors,  rights,  privileges  and  immunities  which  therein  pertain  to  the 
said  degree,  just  as  if  he  had  received  the  said  degree  in  this  University. 

In  witness  of  which  the  Regents  of  the  University  of  Maryland  have  caused 
this  certificate  to  be  issued,  fortified  by  the  common  seal  of  the  University 
of  Maryland  and  signed  by  the  Provost  and  by  the  Dean. 

[signed]  Thomas  Fell,  Ph.D.,   LL.D.,   D.C.L., 

Provost. 
R.  Dorset  Coale,  Ph.D.,  M.D., 

Dean. 


CORRESPONDENCE  .  217 

CORRESPONDENCE 

24  Gower  Street, 
St.  Johns,  Newfoundland. 
Wm.  S.  Gardner,  M.D. 

Dear  Sir  :  In  looking  over  the  Bulletin  of  The  University  of  Mary- 
land School  of  Medicine  and  College  of  Physicians  and  Surgeons 
I  notice  you  have  a  few  items  telling  of  the  doings  of  the  old  boys. 

I  have  recently  been  appointed  physician  to  the  Total  Abstinence  and 
Benefit  Society  of  St.  Johns,  Newfoundland. 

Wishing  you  success  in  your  amalgamation  and  the  future  good  of  old 
P.  &S. 

Yours  truly, 

J.  Clarence  MacDonald, 
Class  P.  &  S.,  1903. 

Prof.  Randolph  Winslow,  ^      ' 

University  of  Maryland. 
My  dear  Professor  Winslow:  It  gives  me  a  great  pleasure  to  inform  you 
that  I  successfully  passed  my  state  board  examinations.  I  am  working  in 
my  home  town  doing  all  kinds  of  work  and  with  great  success.  You  can't 
imagine  how  much  is  helping  me  the  last  year  I  spent  in  the  University  Hospital. 
I  am  trying  to  save  some  money  to  go  back  to  the  University  Hospital  to 
improve  my  little  experience. 

I  would  like  to  have  my  diploma  for  one  year  of  clinical  work  in  the  Uni- 
versity Hospital.  I  certainly  will  highly  appreciate  it  if  you  will  kindly 
send  it  to  me  at  your  earliest  convenience. 

With  my  best  wishes  and  regards  for  all  I  remain. 

Your  obedient  pupil, 

M.  G.  DE  Quevedo  y  Rios, 
Porto  Rico. 

Cairo,  January  30,  1917. 
Prof.  R.  Winslow, 

Dear  Sir:  Today  and  not  before  I  began  to  appreciate  the  value  of  hard 
work  and  study  which  I  went  through  at  beloved  University  of  Maryland.  I 
feel  so  proud  of  that  dear  institution  indeed.  You  will  be  glad  to  hear  from 
me  I  am  sure  if  I  stated  my  work  which  I  have  done  last  year  at  C.  M.  S.  Hos- 
pital, Old  Cairo.  I  do  that  just  to  please  you  and  other  Drs.  and  Profs,  under 
whom  I  studied. 
I  beg  to  remain. 

Yours  very  truly, 

A.  J.  Shakhashiri, 
C.  M.  S.  Hospital, 
Old  Cairo,  Egypt. 

List  of  cases  operated  on  by  Dr.  Shakhashiri 
85  Herniotomies  1  Amputation  of  leg 

7  Hydrocele  1  Lymphatic  gland  of  cervical 

841  Piles  42  Scraping 

30  Fistulae  in  ano  186  Abscesses 

2  Urinary  fistulae  66  Teeth 


BULLETIN 

OF    THE 

University  of  Maryland  School  of  Medicine 

AND 

College  of  Physicians  and  Surgeons 


Publication  Committee 

Randolph   Winslow,  A.M.,  M.D.,  LL.D.  Wm.  S.  Gardner,  M.D. 

J.  M.  H.  Rowland,  M.D. 

Nathan  Winslow,  A.M.,  M.D.,  Editor 

Associate  Editors 

Albert  H.  Carroll,  M.D.  .Andrew  C.  Gillis,  A.M.,  M.D. 

John  Evans,  M.D. 


The  Campaign  for  the  Maryland  General  Hospital 

We  are  happy  to  announce  the  success  of  the  campaign  to  raise 
$150,000  for  the  Maryland  General  Hospital;  indeed,  this  amount 
was  more  than  secured,  as  the  total  sum  realized  was  over  $153,000. 
For  years  this  hospital  has  been  burdened  with  a  heavy  debt,  which 
materiall}^  retarded  its  progress  and  diminished  its  field  of  usefulness. 
Now  it  will  be  able  to  meet  its  obligations  and  make  needed  improve- 
ments in  its  plant.  This  hospital  is  one  of  the  largest  institutions 
for  the  care  of  the  sick  in  the  city,  and  is  favorably  located  for  its 
work.  It  was  formerly  the  property  of  the  Baltimore  Medical 
College  but  was  sold  to  the  Methodist  Hospital  Association,  which 
now  owns  it,  though  the  attending  staff  consists  chiefly  of  the 
former  professors  of  the  college.  By  contract  the  clinical  control 
of  the  hospital  is  vested  in  the  University  of  Maryland,  and  it 
is  an  important  factor  in  the  cHnical  instruction  of  our  students. 
We  rejoice  that  the  people  of  Baltimore  have  shown  their  apprecia- 
tion of  the  work  of  this  worthy  institution  in  the  way  that  counts 
the  most,  to  wit,  by  giving  it  the  means  to  continue  its  beneficent 
efforts. 

The  Endowment  Fund  of  the  University  of  Maryland 

From  the  report  of  Mr.  Charles  Markell,  Treasurer,  we  learn 
that  the  fimds  in  the  hands  of  the  Trustees  of  the  Endowment  Fund 

218 


EDITORIALS  219 

now  amount  to  $54,848.49.  No  special  effort  has  been  made  during 
the  past  year  to  raise  money  for  this  fund  and  the  several  thousand 
dollars  increase  is  due  to  the  natural  increment  of  interest  and  a 
legacy  of  $2500  devised  by  the  late  Dr.  Saint  Clair  Spruill.  A 
proposition  was  made  to  us  to  start  a  campaign  to  raise  funds  and 
a  committee  was  appointed  to  consider  the  matter  but  nothing  of 
material  advantage  accrued.  The  writer  again  wiahes  to  sound  the 
alarm.  In  almost  every  city  and  state  tremendous  efforts  are 
being  made  to  get  their  medical  schools  on  a  solid  basis  by  an  adequate 
endowment.  The  medical  school  of  the  University  of  Maryland 
needs  $1,000,000  to  place  it  on  a  sure  foundation.  We  have  wonder- 
ful cHnical  facihties,  with  3  large  general  hospitals  and  13  or  more, 
special  and  affiliated  hospitals,  but  we  need  money  to  secure  full- 
time  teachers,  both  chnical  and  laboratory  men,  who  shall  devote 
their  energies  to  teaching  and  research.  Through  the  beneficence 
of  the  State  we  have  received  a  liberal  appropriation  for  two  years 
but  we  should  not  depend  entirely  on  the  State,  we  should  stir  our- 
selves to  raise  additional  funds  as  a  permanent  endowment.  The 
next  two  years  will  be  lean  ones,  as  we  shall  certainly  have  small 
classes  until  prospective  patrons  have  time  to  adjust  themselves  to 
the  increased  requirement  of  2  years  of  college  work.  In  the  mean- 
while we  are  still  ready  to  receive  contributions  to  the  pathological 
fund  or  for  any  special  purpose. 

Death  of  Dr.  Elmer  Newcomer 

On  March  11,  1917,  after  a  brief  illness.  Dr.  Elmer  Newcomer 
succumbed  to  a  general  streptococcus  infection,  aged  28  years. 
He  was  a  bright  young  man  with  a  very  promising  future  as  a  sur- 
geon. He  graduated  at  the  University  of  Maryland  in  1913  and 
after  serving  three  years  as  assistant  resident  surgeon  at  the  Uni- 
versity Hospital,  for  two  of  which  he  was  also  assistant  medical 
superintendent,  he  was  appointed  medical  superintendent  of  the 
Maryland  General  Hospital  in  June,  1916,  and  served  most  accept- 
ably in  that  capacity  to  the  time  of  his  death.  He  had  become 
somewhat  run  down  but  seemed  to  have  recovered  when  he  was 
stricken  a  week  ago  with  an  obscure  disease  that  baffled  his  physi- 
cians, until  a  blood  culture  was  made  which  showed  the  strepto- 
cocci in  pure  culture.  The  portal  of  entry  is  unknown,  as  he  had 
received  no -wound  or  injury,  but  probably  the  disease  began  in  the 


220  DEATHS 

sinuses  or  tonsils.  He  was  born  in  Washington  County,  near 
Hagerstown,  to  which  place  his  remains  were  conveyed  for  inter- 
ment. Through  his  death  University  circles  have  met  with  a  great 
loss  and  he  will  be  missed  by  many  friends. 

DEATHS 

On  February  8,  1917,  after  a  short  illness  from  pneumonia,  Miss 
Edna  May  John,  a  graduate  of  the  Nurses  Training  School  of  the 
University  Hospital,  Class  of  1916,  died  at  the  University  Hospital. 
Miss  John  was  highly  esteemed  both  as  a  nurse  and  as  a  lady. 

Mrs.  William  Ellicott  Tyson,  wife  of  Dr.  William  Ellicott  Tyson, 
died  February  27  at  her  home  in  Detroit.  Besides  her  hushand 
she  is  survived  by  three  children. 

Dr.  Tyson  graduated  in  medicine  from  the  University  of  Mary- 
land in  1905. 

Mrs.  Louise  Watkins  Maldeis,  wife  of  Dr.  Howard  J.  ]VIaldeis, 
died  at  her  home,  3006  Kate  Avenue,  after  a  week's  illness,  from 
pneumonia. 

Besides  her  husband  she  is  survived  by  two  children,  Howard  J. 
Maldeis,  Jr.,  and  Cecil  Maldeis. 

Mrs.  Maldeis  was  before  her  marriage  a  nurse  at  the  University 
Hospital,  class  of  1913. 

Dr.  Ernest  Harrison  Rowe,  an  eye  and  ear  specialist,  died  on 
March  13,  at  his  home  in  the  Homewood  Apartments,  following  an 
attack  of  tonsillitis  and  grip. 

Born  in  Baltimore,  Dr.  Rowe  was  34  years  old.  He  received  his 
education  at  the  Milton  Academy  and  later  graduated  in  medicine 
at  the  University  of  Maryland.  He  practiced  in  Alabama  a  short 
time,  and,  returning  to  Baltimore,  took  a  special  course  in  the 
treatment  of  the  eye  and  ear.  Tliree  years  ago  he  went  to  Vienna, 
where  he  continued  his  studies,  and,  returning  to  this  city,  estab- 
lished his  office  at  518  Park  avenue,  and  entered  into  practice. 

Dr.  Gordon  T.  Simonson,  one  of  the  most  prominent  physicians 
in  the  lower  part  of  the  county,  died  at  his  home  on  Main  street, 
Crisfield,  on  March  3,  from  complications  resulting  from  a  fractured 


ITEMS  221 

ankle,  which  he  sustained  some  time  ago  while  visiting  a  patient  in 
the  country. 

He  remained  home  for  several  days  and  then  when  he  became 
worse  was  carried  to  the  University  of  Maryland  Hospital,  where 
he  gradually  recovered  and  seemed  on  the  road  to  regain  his 
former  excellent  health. 

ITEMS 

Dr.  Wilbur  Pledge  Stubbs,  U.  of  Md.  1902,  desires  to  announce 
the  removal  of  his  office  and  residence  to  1706  Eutaw  Place,  Con- 
sultation hours,  9  to  10  a.m.,  7  to  8  p.m.,  and  by  appointment. 
Telephone,  Madison  127. 

Dr.  John  E.  S.  Davidson,  U.  of  M.  1894,  wishes  to  announce  to 
the  profession  that  in  the  future  his  work  will  be  confined  to  der- 
matology and  syphilology,  McKinnon  Building,  Charlotte,  N.  C. 

Mrs.  William  Micou  Jordan  announces  the  marriage  of  her  daugh- 
ter Kate  to  Dr.  Homer  Bates  Jester,  on  Wednesday,  February  14, 
1917,  Tallassee,  Alabama. 

Dr.  Jester  graduated  from  the  College  of  Physicians  and  Surgeons 
class  of  1901. 

The  second  examination  to  be  given  by  the  National  Board  of 
Medical  Examiners  will  be  held  in  Washington,  D.  C,  June  13,  1917. 
The  examination  will  last  about  one  week. 

The  following  states  will  recognize  the  certificate  of  the  National 
Board:  Colorado,  Delaware,  Idaho,  Iowa,  Kentucky,  Maryland, 
North  Carolina,  New  Hampshire,  North  Dakota  and  Pennsylvania. 

A  successful  applicant  may  enter  the  Reserve  Corps  of  either  the 
Army  or  Navy  without  further  professional  examination,  if  their 
examination  papers  are  satisfactory  to  a  Board  of  Examiners  of 
these  Services. 

The  certificate  of  the  National  Board  will  be  accepted  as  quali- 
fication for  admittance  into  the  Graduate  School  of  the  University 
of  Minnesota,  including  the  Mayo  Foundation. 

Application  blanks  and  further  information  may  be  obtained 
from  the  Secretary,  Dr.  J.  S.  Rodm.an,  2106  Walnut  Street,  Phila- 
delphia. 


222  ITEMS 

Dr.  L.  J.  Smith,  U.  of  M.  1903,  of  Ridge  Spring,  S.  C,  and  Dr. 
P.  C.  Carter,  U.  of  M.  1916,  of  Goldsboro,  N.  C,  recently  visited 
the  University. 

Dr.  J.  Thorkelson,  C.  P.  &  S.  1911,  of  Dillon,  Montana,  is  spend- 
ing a  few  days  here  visiting  the  College  and  Mercy  Hospital. 

Dr.  N.  A.  Christenson,  C.  P.  &  S.  1914,  now  located  in  Philadel- 
phia, Pa.,  recently  visited  the  College  and  Mercy  Hospital. 


DR.  WM.  F.  LOCKWOOD 


BULLETIN 

OF  THE 

University  of  Maryland  School 
OF  Medicine 

AND 

College  of  Physicians  and 
Surgeons 

Successor  to  The  Hospital  Bulletin,  of  the  University  of  Maryland, 
Baltimore  Medical  College  News,  and  the  Journal  of  the  Alumni  Asso- 
ciation of  the  College  of  Physicians  and  Surgeons 

Vol.  I  APRIL,  1917  No.  9 

TRIBUTE  TO  DR.  LOCKWOOD 

On  March  22,  the  Research  Society,  which  was  formed  more 
than  a  dozen  years  ago  by  about  fifteen  members  of  the  faculty 
and  teaching  staff  of  the  College  of  Physicians  and  Surgeons,  held 
a  meeting  at  the  University  Club.  After  dining,  the  Society  pre- 
sented to  Dr.  William  F.  Lockwood  two  bound  volumes  made  up 
of  reprints  of  scientific  and  clinical  papers  by  the  various  members 
which  had  appeared  in  journals  between  the  years  1910  and  1916. 
The  contributions  to  medical  literature  totaled  138  and  included 
Medicine,  Surgery,  Pathology,  Bacteriology  and  the  specialties. 
The  presentation  was  made  by  Dr.  Harry  Friedenwald  who  read 
the  Foreword  of  the  volumes  which  is  given  below.  Dr.  Lockwood 's 
acknowledgment  showed  a  keen  and  grateful  appreciation  of  the 
compliment  shown  him. 

The  only  guests  present,  in  addition  to  the  members  were  Dr. 
Robert  W.  Johnson  and  Dr.  Thomas  Chew  Worthington,  boyhood 
and  professional  friends  of  Dr.  Lockwood. 

FOREWORD 

There  are  men,  it  is  true  they  are  rare,  who  are  so  modest  in  the  estimate 
of  their  own  worth  that  they  make  it  difficult  for  their  friends  to  speak  of 
their  virtues  for  fear  of  annojdng  or  of  offending  them.  They  oblige  their 
fr  ends  to  speak  about  them  in  their  absence  and  in  a  low  tone  of  voice,  lest  a 
word  of  praise  may  be  overheard.     I  know  no  man  who  better  typifies  this 

223 


224  TRIBUTE   TO    DR.    LOCKWOOD  ^ 

class  than  William  F.  Lockwood,  of  whom  I  have  undertaken  to  write  this 
appreciation.  For  his  friends  of  the  Research  Society  of  the  College  of  Phy- 
sicians and  Surgeons  have  determined  to  give  expression  to  their  esteem,  their 
affection,  and  their  admiration,  and  as  a  token  to  present  Dr.  LockAvood 
with  this  volume  of  their  recent  medical  essays. 

Dr.  Lockwood's  work  has  been  that  of  a  medical  practitioner,  a  teacher 
of  medicine  and  an  organizer  and  administrator  of  a  medical  school.  As  a 
practitioner  his  work  has  been  characterized  by  the  painstaking  inquiry  of 
the  true  student  of  science,  and  the  conscientious  care  of  the  phj^sician  who 
looks  upon  his  profession  as  a  sacred  trust.  This  explains  whj'  he  has  re- 
mained abreast  of  medical  progress  and  as  intensely  interested  in  every  line 
of  development  and  discovery  as  a  recent  graduate.  This  likewise  explains 
why  we  value  so  highly  his  opinion  when  we  meet  with  doubtful  and  difficult 
cases.  His  wise  counsel  in  consultation  together  with  his  kind  and  consid- 
erate treatment  of  fellow-practitioners  have  made  him  an  ideal  consulting 
physician. 

As  a  teacher  of  medicine  he  has  considered  it  his  duty  not  only  to  keep  in 
the  forefront  of  medical  knowledge,  but  to  search  for  the  best  ways  of  impart- 
ing it.  He  was  convinced  long  ago  that  this  could  best  be  accomplished 
not  by  the  old  lecture  system  but  by  those  methods  followed  in  the  modern 
teaching  of  all  the  natural  sciences.  He  has  therefore  la'd  all  possible  stress 
on  the  study  of  disease  in  the  presence  of  the  patient,  in  observing  and  in 
searching  its  manifestations;  his  efforts  have  been  directed  to  proper  training 
in  laboratory  and  clinical  methods  to  equip  the  student  with  the  means  at 
our  command  to  detect  and  discover  the  evidences  of  disease.  He  found 
that  the  intimate  associaltion  of  teacher  and  student  stimulated  the  interest 
of  both,  and  he  has  cultivated  bedside  teaching  in  a  manner  that  has  been  the 
source  of  joy  and  inspiration  to  the  students  as  it  must  have  been  of  keen 
satisfaction  to  himself. 

Dr.  Lockwood's  abilitj'  as  an  orga,nizer  and  administrator  has  shown  itself 
to  best  advantage  when  he  was  Dean  of  the  Faculty  of  the  College  of  Physi- 
cians and  Surgeons.  The  period  daring  which  he  held  this  office  was  the 
most  critical  in  the  history  of  the  institution;  it  was  the  transition  stage 
when  med  cal  colleges  that  had  enjoyed  large  classes  and  therefore  income 
sufficient  for  all  purposes,  were  suddenly  confronted  by  higher  entrance  re- 
quirements and  other  conditions  which  were  imposed  by  various  State  Boards, 
by  the  Association  of  American  Medical  Colleges,  and  by  the  Council  of  the 
American  Medical  Association.  This  sudden  change  in  conditions,  resulting 
in  markedly  decreased  income  and  greatly  increased  expense,  led  to  difficul- 
ties in  the  management  of  the  unendowed  schools,  to  which  many  succumbed. 
It  would  have  been  greatly  to  Dr.  Lockwood's  credit  if  by  careful  manage- 
ment he  had  only  enabled  the  college  to  weather  the  storm.  But  he  did 
much  more.  During  this  period  the  college  was  conducted  better,  he  build- 
ings were  kept  better  and  the  school  was  raised  to  the  highest  point  it  ever 
attained  as  an  institution  of  learning.  The  credit  of  this  belongs  to  Dr. 
Lockwood. 

When  the  ime  came  for  union  of  the  forces  of  the  College  of  Physicians 
and  Surgeons  with  those  of  the  LTniversity  of  Maryland,  the  burden  of  con- 


EPIDEMIC    CEREBRO-SPINAL   MENINGITIS  225 

solidation  rested  in  large  measure  upon  Dr.  Lockwood.  It  was  felt  that  the 
man  who  could  best  steer  the  new  ship, — the  consolidated  school  during  its 
formative  stage,  was  Dr.  Lockwood.  With  a  devotion  as  great  as  were  his 
sacrifices  of  time  and  energy,  he  gave  himself  up  to  making  the  consolidation 
real  and  successful.  None  know  what  it  cost  him,  his  financial  losses  and  his 
loss  of  health.  But  we  do  know  that  his  sole  recompense  was  the  satisfac- 
tion he  had  in  bringing  order  and  system  into  the  large  and  widely  spread 
institution,  and  in  the  consciousness  of  rendering  a  real  service  to  the  ad- 
vancement of  medical  education. 

These  are  some  of  the  reasons  why  his  friends  of  the  Research  Society  de- 
sire to  show  to  Dr.  Lockwood  their  deep  appreciation  of  the  service  he  has 
rendered  and  is  rendering  to  the  profession  of  medicine  and  to  medical  edu- 
cation. There  are  other  reasons,  many  more,  why  they  wish  to  do  so.  But 
these  are  too  intimate  to  put  in  print.  The  personal  qualities  which  have 
called  forth  the  firmest  friendships,  the  deepest  devotion  of  his  colleagues, 
the  highest  admiration  and  esteem  for  lofty  and  noble  character,  are  matters 
which  his  friends  can  only  speak  of  in  their  intimate  intercourse.  This  much 
they  desire  to  give  utterance  to,  that  it  is  their  deepest  wish  that  the  cher- 
ished relations  between  him  and  themselves  may  continue  for  many  years 
during  which  he  will  remain  their  wise  counsellor  and  their  kind  and  beloved 
friend. 

EPIDEMIC  CEREBRO-SPINAL  MENINGITIS 

By  Erwin  E.  Mayer,  M.D. 

Mercy  Hospital,   Baltimore,   Maryland 

Epidemic  cerebro-spinal  meningitis  is  a  disease  which  occurs 
very  infrequently  in  general  hospitals  and  its  comparative  rareness, 
prompts  me  to  write  a  short  paper,  especially  so,  because  we  have 
had  a  very  interesting  case  in  the  hospital  within  the  past  month. 

A  resume  of  the  records  of  the  hospital  for  1914-1916  shows  that 
in  that  time  we  have  had  but  one  other  case  of  the  epidemic  form  of 
meningitis,  the  others  being  classified  as  follows: 

Tubercular 22 

Septic 6 

Pneumonic 5 

We  have  also  had  several  cases  of  syphilitic  meningitis,  but  these 
occurred  during  the  course  of  the  disease  and  were  not  classified  un- 
der separate  headings.  In  addition  we  had  a  case  of  influenza 
with  meningeal  manifestations  as  a  complication. 

Before  proceeding  with  the  actual  reports  of  the  cases,  a  short 
synopsis  of  the  etiology,  symptoms  and  diagnosis  of  this  particular 


226  ERWIN   E.    MAYER 

form  of  meningitis  seems  indicated.  Concerning  the  etiology,  all 
research-workers  are  of  the  opinion  that  the  diplococcus  intracellu- 
laris,  first  described  by  Weichselbaum,  is  the  exciting  cause  of  the 
infection.  It  is  also  agreed  that  the  mode  of  living,  the  housing  con- 
dition and  the  other  unhygienic  circumstances  play  the  same  role 
in  this,  as  they  do  in  other  diseases,  by  lowering  the  resistance  and 
thereby  predisposing  to  illness.  The  entrance  to  the  system  is 
usually  by  way  of  the  upper  air  passages,  the  germs  electing  the  nose 
and  mouth  as  their  points  of  entering  and  then  making  their  way  to 
the  meninges  by  way  of  the  lymphatics  or  the  blood.  Similar  to 
diphtheria  we  know  that  persons  may  act  as  carriers  and  transmit 
the  disease  without  contracting  it  themselves.  Fortunately  the 
majority  of  humans  have  a  natural  immunity  against  epidemic 
meningitis  and  escape  the  contraction  of  the  illness,  even  after  close 
contact  with  the  patient. 

In  discussing  signs  and  symptoms,  it  is  well  to  state  that  pro- 
dromata  are  rare,  the  onset  being  sudden  and  often  accompanied  by 
chill,  vomiting  and  fever.  Following  close  on  this  we  have  hyper- 
esthesia, headache,  stiffness  of  muscles,  stupor  or  delirium,  eye 
symptoms  and  Kernig's  sign.  The  symptoms  may  readily  be  classi- 
fied into  three  distinct  groups. 

I.  Cerebral;  II.  Localized  Nervous;  III.  Constitutional.  In  the 
first  group  we  have  those  symptoms  referable  to  the  brain  and  cord 
as,  headache,  pain  in  nape  of  neck,  opisthotonus,  drowsiness,  delir- 
ium and  cerebral  vomiting.  In  the  second  group  we  have  those 
referable  to  the  eye  as,  nystagmus,  strabismus,  inequality  of  pupils 
and  sluggish  reaction.  Here  also  we  have  deafness,  stiffness  of 
muscles  and  Kernig's  sign.  In  the  third  group  the  constitutional 
manifestations  of  fever,  chill,  herpes,  jaundice,  constipation  and 
emaciation  may  be  classified. 

The  diagnosis  is  in  a  great  measure  closely  related  to  the  proper 
interpretation  of  the  signs  and  symptoms  and  is  actually  confirmed 
by  the  spinal  puncture.  This  latter  however  is  not  resorted  to  un- 
til the  recognition  of  cerebral  irritation  has  been  established  and 
the  sjanptoms  and  signs  mentioned  above  have  shown  the  existence 
of  a  meningitis,  the  only  question  being  the  type.  Cerebro-spinal 
meningitis  must  be  differentiated  from  all  forms  of  meningitis 
as  shown  in  the  classification  and  in  addition  from  t^^phoid,  pneu- 
monia and  all  other  acute  infections.  In  this  differentiation  the 
laboratory  is  of  great  help,  not  only  in  the  examination  of  the  spinal 


EPIDEMIC    CEREBRO-SPIISrAL   MENINGITIS  227 

fluid,  but  also  in  the  condition  of  the  blood.  A  hyperleukocytosis 
in  which  the  polymorphonuclears  predominate  and  in  which  the 
septic  factor,  spoken  of  by  Simon,  is  shown,  is  of  great  aid  in  arriving 
at  the  diagnosis.  The  diplococcus  intracellularis  of  meningitis 
may  also  be  found  in  the  blood  smear,  both  of  our  cases  showing 
this  in  addition  to  their  presence  in  the  spinal  fluid. 

The  diagnosis  depends  mainly  however  on  the  findings  of  the 
spinal  fluid.  A  cloudy  or  purulent  fluid,  escaping  under  pressure, 
containing  leukocytes  in  abundance  is  indicative  of  cerebro-spinal 
meningitis.  The  finding  of  the  diplococcus  under  the  microscope  is 
conclusive  of  the  diagnosis.  The  only  other  organism  which  has  the 
characteristic  appearance  of  this  biscuit-shaped  diplococcus  is  the 
gonococcus.  This  latter  chooses  the  urethra  and  the  adjoining 
organs  as  its  place  of  development,  while  the  meningococcus,  as  it  is 
sometimes  called,  confines  itself  to  the  meningeal  tissues.  The 
cultural  characteristics  and  the  staining  qualities  of  both  organisms 
are  identical. 

In  this  report  a  case  of  septic  meningitis  has  been  included  in  order 
to  demonstrate  how  difficult  the  diagnosis  may  be,  even  after 
lumbar  puncture  has  been  resorted  to  and  before  the  microscopical 
examination  of  the  fluid  has  been  made. 

REPORT    OF    CASES 

Case  1 

L.  E.,  female,  age  25.  Patient  was  picked  up  on  the  street  by  a 
police  officer  and  sent  to  the  hospital  in  the  patrol  wagon.  Date  of 
admission  January  2,  1915.  On  admission  the  patient  was  seen 
by  the  doctor  in  charge  of  the  accident  department,  who  tried  to 
obtain  some  information  regarding  her  illness  and  the  circumstances 
surrounding  her  being  found  on  the  street.  He  was  unable  to  get 
this  information  either  from  the  officer  or  the  patient.  The  former 
saw  her  lying  on  the  pavement,  while  the  patient's  condition 
was  so  serious  that  she  was  sent  to  the  ward  almost  immediately. 
When  admitted  to  the  ward,  patient  had  a  violent  chill  .and  no  at- 
tempt was  made  to  question  or  examine  her  at  that  time,  it  being 
deemed  more  advisable  to  treat  her  symptomatically  for  the  time 
being.  After  the  elapse  of  several  hours  we  decided  to  examine  her 
and  find  out  the  cause  of  her  ailment.  She  had  been  delirious  at 
the  time  of  admission  to  the  hospital  and  was  still  in  the  same  con- 


228  ERWIN   E.    MAYER 

dition.  She  mumbled  several  indistinct  names  and  frequently 
cried  out  as  if  in  pain.  It  was  impossible  for  us  to  obtain  any  his- 
tory of  her  illness.  Physical  examination  somewhat  difficult  on 
account  of  her  delirium  and  restlessness,  revealed  temperature  sub- 
normal, pulse  110  and  respiration  30.  Pupils  reacted  rather  slug- 
gishly to  light  and  there  was  slight  external  strabismus.  The  pres- 
ence of  stiffness  and  rigidity  of  the  muscles  of  the  neck,  trunk, 
arms  and  legs  was  noticed.  Chest  examination  as  well  as  heart 
and  abdominal  was  negative.  A  vaginal  discharge  was  present. 
Altogether  the  physical  examination  was  very  unsatisfactory.  The 
presence  of  Kernig's  sign  was  discussed,  but  there  seemed  to  be  so 
much  general  rigidity,  that  it  could  not  be  made  out  very  well. 
Pelvic  examination  was  negative.  Urine  was  negative.  Blood 
pressure  130.     Examination  of  the  blood  showed: 

Hemoglobin 80 

Total  red 4,100,000 

Total  white 16,000 

Polynuclears 95  per  cent 

Small  mononuclears 3  per  cent 

Large  mononuclears 2  per  cent 

Eosinophiles 0  per  cent 

The  diagnosis  at  this  time  was  in  doubt  and  the  patient  was 
watched  and  given  treatment  as  required  by  her  symptoms.  The 
following  morning  the  signs  of  cerebral  irritation  were  more  marked 
and  a  lumbar  puncture  was  made.  By  this  time  the  patients  con- 
dition has  steadily  progressed  towards  weakness  and  collapse  and 
before  any  treatment  could  be  instituted  she  succumbed.  The  ex- 
amination of  the  spinal  fluid  which  came  from  the  canal  under 
pressure  and  was  cloudy  in  appearance,  showed  the  presence  of  a 
large  number  of  leukocytes  and  an  intracellular  diplococcus  which 
was  diagnosed  as  the  meningococcus. 

Summary. — In  reviewing  this  case  and  summarizing  all  our  posi- 
tive finding,  it  is  easy  enough  with  the  assistance  of  the  spinal 
fluid,  to  make  the  diagnosis  of  epidemic  cerebro-spinal  meningitis. 
It  was  impossible  in  this  case  however  to  make  the  diagnosis  of 
meningitis  before  we  had  all  our  findings  together,  and  then  it  was 
too  late  to  do  anything  that  might  have  saved  her  life.  Even  after 
her  death  we  were  unable  to  obtain  a  history  either  from  friends  or 
relatives  as  her  home  was  out  of  town  and  no  Hght  could  be  obtained 
from  any  source. 


EPIDEMIC    CEREBRO-SPINAL   MENIX    ITIS  229 

The  spinal  fluid  in  this  case  was  examined  by  Dr.  Simon,  who  also 
demonstrated  the  meningococcus  in  the  blood  smear  and  verified  our 
findings. 

Case  2 

This  case  is  reported  to  show  the  similarity  which  may  exist  in 
other  forms  of  meningitis  and  because  the  patient  was  admitted  to 
the  hospital  within  ten  days  after  the  first  case. 

C.  MacC,  male,  aged  23.  Patient  was  sent  to  the  hospital  by  his 
attending  physician  on  January  15,  1915.  He  was  seen  by  the  doc- 
tor in  charge  of  the  accident  room  and  sent  to  the  ward  with  a  diag- 
nosis of  meningitis.  There  was  a  history  of  headache,  stiffness  of 
neck,  sore  throat  and  delirium.  The  family  history  was  negative. 
The  past  history  showed  that  he  had  diphtheria  at  5,  tonsillitis  at 
13  and  rheumatism  at  21. 

Present  Illness. — Three  days  before  admission  of  the  patient  to  the 
hospital,  he  was  taken  suddenly  ill  while  seated  at  the  supper  table. 
He  was  seized  with  a  pain  in  the  neck,  could  not  swallow  and  fell 
to  the  floor.  He  shortly  developed  rigidity  of  the  arms  and  legs, 
also  the  neck.  A  physician  was  called  who  had  him  put  to  bed 
and  watched.  He  remained  at  home  for  two  days  and  was  then 
sent  to  the  hospital. 

Physical  examination.— Peitient  was  very  restless,  seems  to  be 
suffering  quite  a  good  deal  of  pain  and  was  almost  in  the  position  of 
opisthotonus.  Neck  was  markedly  rigid  and  retracted.  Body 
likewise.  Thighs  are  flexed  on  abdomen  and  limbs  on  thighs. 
Pupils  are  unequal  and  there  was  inflammation  of  conjunctiva. 
Throat  was  red,  grayish  membrane,  which  can  be  easily  wiped  off 
was  present.  There  was  marked  hyperesthesia  of  the  skin  and  a 
positive  Kernig's  sign  was  present.  Temperature,  102,  pulse,  120, 
respirations,  32,  blood  pressure,  110,  urine  showed  trace  of  albumen. 

Blood  examination  shows: 

Hemoglobin 90 

Total  red 4,300,000 

Total  white 13,500 

Polynuclears 88  per  cent 

Small  mononuclears 4  per  cent 

Large  mononuclears 7  per  cent 

Eosinophiles 0  per  cent 

Basophiles 1  per  cent 


230  ERWIX    E.    MAYER 

Throat  examination  by  laryngologist  showed  grayish  membrane, 
probably  streptococcus.  Four  hours  after  admission  of  patient  to 
hospital  a  lumbar  puncture  in  order  to  help  us  in  arriving  at  a 
definite  diagnosis,  was  made.  Cloudy  fluid  under  much  pressure 
was  withdrawn.  The  patient  was  given  right  then  and  there  30  cc. 
of  Flexner's  anti-meningococcus  serum.  Microscopical  examination 
of  the  fluid  showed  abundance  of  leukocytes  but  no  meningococci 
were  found.     Cultures  were  made  but  no  germs  were  isolated. 

Summary. — This  patient  made  an  uneventful  recovery,  his  symp- 
toms being  much  improved  after  the  withdrawal  of  the  spinal  fluid. 
Many  authors  recommend  the  giving  of  serum  almost  at  once,  after 
the  spinal  fluid  has  been  withdrawn.  In  this  case  the  appearance 
of  the  spinal  fluid  grossly,  taken  in  conjunction  with  our  other 
symptoms  and  signs  warranted  the  giving  of  the  serum  before  mi- 
croscopical examination  of  the  fluid  was  made.  The  patient  was 
able  to  leave  the  hospital  within  two  weeks  and  all  his  symptoms 
cleared  up  very  promptly.  The  findings  here  demonstrate  the 
difficulty  which  may  be  encountered  in  arriving  at  a  correct  diagnosis. 

Case  3 

F.  E.,  age  19.  Electric  crane  operator.  Native  of  North  Caro- 
lina.    Admitted  to  hospital  March  13,  1917. 

Note  on  admission. — Patient  was  sent  to  hospital  by  one  of  the 
outside  physicians,  having  been  ill  since  March  11,  1917,  at  7  p.m 
History  given  by  attending  physician  as  follows.  Patient  was 
taken  sick  on  Sunday  evening,  March  11,  with  a  chill,  having  been 
previously  well  all  day.  Following  chill  he  had  a  temperature  of 
103.  This  temperature  continued  all  night  and  in  the  morning  at 
5,  when  again  sent  for  the  patient  had  a  temperature  of  105,  pulse 
140,  was  delirious  and  appeared  very  ill.  No  definite  diagnosis 
could  be  made  at  that  time  and  he  was  treated  symptomatically. 
The  day  after  having  been  taken  ill,  the  temperature  continued  to 
remain  between  102  and  103.  Patient  vomited,  had  intense  head- 
ache, was  more  or  less  deHrious  all  day  and  seemed  to  be  getting 
into  a  stupor.  Patient  was  sent  to  hospital  on  March  15,  two  days 
after  onset  of  illness  and  admitted  as  a  case  of  "pneumo-typhoid." 
No  definite  diagnosis  had  been  made  at  this  time.  Previous  to  his 
illness  patient  had  been  working  at  Sparrows  Point  for  about  one 
month.     Before  that  in  Philadelphia  for  two  months  and  before  that 


EPIDEMIC    CEREBRO-SPINAL   MENINGITIS  231 

in  Baltimore  as  a  car  conductor.  He  lived  in  an  up-town  neighbor- 
hood under  good  hygienic  surroundings. 

Physical  examination  on  admittance  to  hospital.  Young  man, 
appears  very  ill,  semi-conscious,  stuporous,  disoriented  and  drowsy. 
Does  not  remember  when  he  was  taken  ill  and  seems  disinclined  to 
answer  questions.  As  soon  as  patient  was  put  to  bed  he  went  to 
sleep.  Complained  of  pain  in  head.  Examination  at  this  time 
showed  the  following  positive  signs.  Eyes  are  rolled  up,  conjunc- 
tivitis is  present  and  also  a  slight  external  strabismus.  Lips 
has  several  herpes  in  corners.  On  attempting  to  raise  head,  neck 
muscles  were  found  to  be  painful.  Patient  could  not  put  chin  on 
chest  and  neck  was  very  rigid.  Examination  of  chest  and  heart 
was  negative.  Temperature  was  100.4°,  pulse  80,  respiration  26. 
Blood  pressure  120.  Abdominal  muscles  were  rather  rigid,  and  there 
was  some  retraction  of  muscles.  Kernig's  sign  was  positive.  Super- 
ficial reflexes  were  present  but  not  increased. 

Following  the  finding  of  cerebral  irritation  it  was  deemed  essen- 
tial that  a  blood  examination  be  made  which  showed  the  following: 

Hemoglobin 85 

Total  red 4,200,000 

Total  white 48,000 

Polynuclears 96  per  cent 

Small  mononuclears 2  per  cent 

Large  mononuclears 2  per  cent 

Eosinophiles 0  per  cent 

Basophiles 0  per  cent 

Urinalysis  showed  a  trace  of  albumin. 

With  the  above  findings  which  were  so  far,  history  of  sudden 
onset,  chill,  vomiting,  stupor,  delirium,  strabismus,  neck  rigidity, 
retraction  of  abdomen,  Kernig's  sign,  septic  factor,  hyperleukocy- 
tosis,  the  only  proper  mode  of  procedure  was  lumbar  puncture. 
Lumbar  puncture  was  made  two  hours  after  the  patient  was  ad- 
mitted to  the  hospital.  At  this  time  we  obtained  spinal  fluid  under 
marked  pressure,  cloudy,  almost  purulent,  quantity  was  about  50 
cc.  Microscopical  examination  showed  abundance  of  leukocytes 
and  an  intracellular  diplococcus  which  was  diagnosed  as  a  definite 
meningococcus. 

Patient  was  given  by  gravity  method  30  cc.  of  antimeningococcus 
serum.  Patient  felt  much  relieved  after  lumbar  puncture.  No 
other  symptoms  were  noted  and  he  was    allowed  to  remain   very 


232  ERWIN    E.    MAYER 

quiet,  with  ice  cap  to  head,  water  ad  lib.,  etc.  The  patient  spent 
a  rather  comfortable  night  and  early  the  next  morning  he  seemed 
quite  a  good  deal  better.     Nothing  more  was  attempted  on  this  day. 

March  15  (two  days  after  admission),  patient  seems  somewhat 
drowsy  today,  neck  rigiditj'  not  so  marked  and  Kernig's  sign  not  so 
pronounced.  It  was  deemed  advisable  however  to  obtain  some 
more  spinal  fluid  and  determine  the  exact  condition.  Lumbar 
puncture  was  done  and  cloudy  fluid  again  escaped,  pressure  not 
quite  so  marked.  Microscopical  examination  showed  vast  num- 
ber of  leukocytes,  but  meningococci  were  much  less  in  evidence. 
Some  little  difficulty  was  encountered  before  we  were  able  to  dem- 
onstrate the  organisms.  Patient  was  given  30  cc.  more  of  serum 
by  gravity  method. 

INIarch  16,  patient's  condition  much  improved.  Temperature 
normal.  From  this  time  on  patient  made  progress  each  day  and 
symptoms  began  to  gradually  disappear.  Patient  had  a  little  head- 
ache now  and  then,  but  otherwise  was  free  from  all  symptoms. 

March  25,  patient  complained  of  some  headache.  General  con- 
dition good.  Temperature  has  been  normal  for  almost  a  week. 
In  order  to  be  perfectly  sure  of  what  was  taking  place  in  the  spinal 
canal  and  to  make  sure  also  that  there  was  no  return  of  imtoward 
symptoms,  a  lumbar- puncture  was  made.  The  fluid  flowed  out  of  the 
needle  drop  by  drop,  was  perfectly  clear  and  from  gross  examina- 
tion looked  like  normal  spinal  fluid.  Microscopical  examination 
showed  normal  cell  count.  Absence  of  meningococci.  Cultures 
taken  from  the  nose  and  throat  of  this  patient  were  negative.  He 
was  able  to  leave  the  hospital  on  March  30,  1917,  feeling  perfectly 
well. 

CONCLUSIONS 

This  last  case  demonstrates  clearly  the  dependence  of  treatment 
on  early  diagnosis.  The  chief  reason  for  missing  a  diagnosis  of 
cerebro-spinal  meningitis  is  due  to  the  fact  that  the  average  practi- 
tioner has  seen  but  a  very  few  cases  of  this  disease,  if  any  at  all.  In 
addition  to  this,  the  comparative  frequency  of  other  diseases  which 
have  a  somewhat  similar  onset  is  quite  large  and  epidemic  menin- 
gitis, especially  sporadic,  is  far  removed  from  the  mind  of  the  exam- 
iner. Sporadic  cases  however  do  occur  and  may  do  so  without  any 
previous  warning. 

During  an  epidemic  of  meningitis,  where  cases  break  out  in  rota- 


SEXUAL   IMPOTENCE  233 

tion,  the  doctors,  health  officials  and  the  laity  are  all  on  the  lookout 
for  symptoms,  which  are  characteristic  of  the  disease.  Under  such 
circumstances  the  diagnosis  can  be  made  reasonably  early  and  the 
proper  treatment  instituted  without  loss  of  time.  The  other  lone 
case  though,  which  may  develop  anywhere  and  anytime,  catches 
one  so  to  speak  "off  his  guard"  and  unless  great  care  is  taken,  we 
will  lose  the  patient  before  treatment  can  be  given. 

The  facilities  for  obtaining  a  lumbar  puncture  and  the  subsequent 
examination  of  the  spinal  fluid  must  be  taken  into  consideration. 
It  is  not  always  an  easy  procedure  and  very  often  great  difficulty 
may  be  experienced  in  a  home  without  proper  assistance.  In  hos- 
pitals where  the  obtaining  of  spinal  fluid  is  done  frequently  and 
where  the  convenience  of  laboratory  is  always  available,  the  per- 
formance of  lumbar  puncture  can  be  done  without  any  real  trouble 
and  the  result  of  the  microscopical  examination  reported  in  a  very 
short  while.  The  giving  of  the  serum  in  the  spinal  canal  may  also 
be  accompanied  by  some  difficulty  and  should  hardly  be  attempted 
without  assistance  or  one  may  find  himself  in  deep  trouble. 

It  is  far  better  if  any  way  possible,  to  have  the  patient  removed  to 
a  hospital,  where  these  things  can  be  done  quickly  and  aseptically 
and  where  the  patient  can  be  under  constant  observation. 

SEXUAL  IMPOTENCE! 

By  Herbert  Schoenrich,  M.D. 
Baltimore,  Maryland 

That  the  sexual  function  is  of  very  great  consequence  to  the  in- 
dividual as  well  as  to  society,  no  one  will  deny.  The  energy  of  man, 
his  courage,  his  enjoyment  of  work  and  life,  his  affection  towards 
the  opposite  sex,  his  love  for  his  wife  and  home,  with  hardly  any 
exception  depends  largely  on  his  sexual  power.  To  quote  Krafft- 
Ebing: 

The  sexual  function  forms  the  most  powerful  factor  in  individual  and  so- 
cial life.  It  is  a  mighty  impulse  for  bringing  into  action  our  most  effective 
energies,  for  acquiring  property,  for  the  foundation  of  a  home,  for  arousing 
altruistic  feelings  for  a  person  of  the  other  sex  first,  and,  later,  for  one's  chil- 
dren, and  in  a  wider  sense,  for  the  whole  human  family. 

1  Read  before  the  Lister  Society,  Baltimore,  Md.,  May,  1916. 


234  HERBERT    SCHOENRICH 

One  of  the  most  depressing  and  deplorable  conditions  is  when  a 
man  finds  himself  becoming  impotent.  He  is  embarrassed,  ashamed, 
ill-humored  and  melancholy.  He  is  anxious  to  conceal  his  affliction, 
and  often  reproaches  himself  believing  that  he  was  possibly  the 
cause  of  his  own  misfortune.     Then  further,  as  Vecki  states: 

No  one  is  more  severe  than  the  impotent  in  passing  judgment  on  his  neigh- 
bor. No  one  so  ruthlessly  or  mercilessly  condemns  a  misdeed  caused  by  pas- 
sion, against  the  very  wise  prescripts  of  Ethics.  Since  he  cannot  join  the 
virile  in  their  enjoyments  of  life,  he  makes  a  merit  of  his  incapacity. 

Without  viriUty  there  can  be  no  procreation,  thus  the  stimulus 
for  a  striving  man  to  found  for  himself  a  happy  home  and  family, 
is  reduced  to  a  minimum.  In  view  of  these  facts,  it  is  to  be  re- 
gretted that  the  profession  has  not  sufficiently  awakened  to  a  wider 
realization  of  the  importance  of  this  condition  and  that  this  sub- 
ject is  still  to  a  large  degree  in  the  tenacious  grasp  of  the  most  ram- 
pant charlatans.  Although  recent  medical  literature  has  added 
very  little  new  light  on  this  subject,  yet  the  prevalence  of  the  malady 
and  its  unfortunate  and  often  serious  consequences  and  the  fact  that 
it  is  so  often  neglected  prompts  me  to  select  this  subject  as  the  topic 
of  my  paper  this  evening. 

When  a  man  is  unable  to  successfully  perform  the  sexual  act,  due 
to  some  psychic  or  physical  morbid  condition,  he  is  said  to  be  im- 
potent even  though  his  semen  contains  spermatozoa.  Impotence 
must  however  be  distinguished  from  sterility,  for  in  this  condition, 
the  individual  is  unable  to  procreate  owing  to  the  absence  of  sper- 
matozoa in  his  semen,  as  may  occur  after  a  bilateral  epididymitis; 
thus,  a  sterile  person  is  not  necessarily  impotent  nor  vice  versa.  We 
distinguish  two  classes  of  sexual  impotence:  (1)  That  due  to  some 
anatomical  defect  in  the  genital  organs,  thereby  mechanically  inter- 
fering with  the  sexual  act  (Impotentia  Organica) ;  (2)  functional  dis- 
turbances (Impotentia  Coiundi). 

ANATOMICAL  DEFECTS 

These  are  congenital  or  acquired.  Congenital  malformations  are 
rarely  met  with,  as  absence  of  the  penis  or  nondescent  of  the  tes- 
ticles (Cryptorchidia) .  During  my  experience  in  practice  and  as 
surgeon  in  the  National  Guard  where  I  have  made  physical  exami-. 
nations  on  hundreds  of  recruits,  I  only  found  two  cases  where  but 
one  testicle  had  descended  (monorchidia) ,  and  one  case  of  an  ab- 


SEXUAL    IMPOTENCE  235 

normally  small  penis.  There  are  not  many  cases  recorded  where 
congenital  malformations  interfered  with  copulation,  however,  the 
following  conditions  may  occur:  extreme  epispadias;  hypospadias  of 
the  perineal  and  scrotal  urethra;  defective  development  of  the  erec- 
tile tissue,  in  which  the  penis  may  be  sufficiently  large  but  abnor- 
mally flabby.  Phimosis  may  act  as  a  hindrance  to  the  sexual  act, 
interfering  with  erection  or  be  the  cause  of  premature  ejaculation. 
The  acquired  defects  are  more  common.  The  most  complete,  is  the 
amputation  or  loss  of  the  penis  and  testicle  as  the  result  of  disease, 
or,  in  the  case  of  eunuchs  where  the  genitals  have  been  removed  in 
early  life.  In  the  Orient,  records  show,  that  eunuchs  that  had  the 
penis  and  testicles  removed  brought  a  higher  price  than  when  only 
the  testicles  had  been  removed.  Atrophy  of  the  testicles,  extreme 
scrotal  hernia  and  hydrocele,  malignant  growths,  tumors,  gunshot 
wounds,  stricture,  mutilations  and  phagedenic  ulcerations  of  the 
penis  may  all  act  as  anatomical  defects. 

FUNCTIONAL   DISTURBANCES 

Functional  disturbances,  by  far,  play  the  most  important  role  as 
a  causative  factor  of  sexual  impotency.  Before  considering  the 
pathogenesis  of  such  disturbances,  permit  me  first  to  review  briefly 
the  physiological  phenomena  entering  into  the  sexual  act.  This-  de- 
pends upon  the  presence  of  the  normal  sexual  impulse,  the  center 
of  which  is  in  the  brain  (according  to  Gall,  it  is  located  in  the  cere- 
bellum). After  the  age  of  puberty,  this  instinct,  through  various 
circumstances  associated  with  the  female  sex  or  lustful  impressions, 
etc.,  can  be  heightened  to  sexual  fervor  (libido)  and  automatically, 
through  complicated  sexual  reflex  processes  acting  upon  the  erectile 
and  ejaculatory  center  in  the  spinal  cord,  produces  erection  and 
ejaculation,  accompanied  by  the  presence  of  voluptuous  sensations. 
The  sexual  instinct  in  the  brain  is  independent  from  the  spinal 
center.  This  has  been  demonstrated  on  animals  where  that  part  of 
the  cord  containing  the  center  has  been  removed,  and  the  copulative 
desire  remained.  The  sexual  reflex  phenomena,  however,  |are  under 
the  control  of  the  cerebrum,  which  on  the  one  hand  sends  impulses 
to  the  spinal  and  sympathetic  centers,  but  on  the  other  hand  con- 
trols their  activity  by  inhibition.  Disorders  in  potency  may  be 
produced  by  changes  in  the  libido,  erectile  faculty  and  in  the  ejacu- 
latory function.     T  will  discuss  these  changes  in  this  respective  order. 


236  HERBERT    SCHOENRICH 

although  it  must  be  remembered  that  this  classification  is  only  rela- 
tive since  one  or  all  of  these  functions  may  become  synchronously 
affected,  or  closely  follow  one  another  from  the  same  cause. 

a.  Changes  in  the  libido  (sexual  lust).  As  has  been  stated,  this 
center  is  located  in  the  brain,  and  sexual  excitement  is  usually 
brought  about  through  this  medium.  The  normal  sexual  power 
and  its  duration  in  man  is  subject  to  wide  variation  and  just  where 
a  man's  sexual  capacity  ceases  and  pathological  weakness  begins, 
there  is  no  fine  line  of  division.  Furthermore,  much  depends  upon 
age,  climate,  inherited  and  acquired  disposition,  race  education  and 
external  influences.  Thus,  puberty  coming  on  late,  and  an  early 
decline  of  the  Ubidinous  instinct  may  be  purely  physiological;  so 
also,  is  the  condition  known  as  "Natura  Frigida,"  a  natural  in- 
herited sexual  disinclination.  Constitutional  diseases  suppress  the 
sexual  desire,  either  partially  or  completely,  particularly  febrile  and 
constitutional  diseases  and  those  accompanied  by  pain.  Typhoid 
fever,  diphtheria,  erysipelas  and  malaria  are  sometimes  followed  by 
impotence.  In  typhoid  especiall}^,  months  may  elapse  before  the  re- 
viving of  the  desire.  Again,  the  contrary  may  be  seen  in  tubercu- 
losis, where  the  desire  may  be  augmented.  The  awakening  of  the 
sexual  desire  at  puberty  is  said  to  be  due  to  an  internal  secretion 
of  the  genital  gland;  the  senile  involution  of  the  glands  setting  a 
limit  to  this  impulse.  That  there  seems  to  be  a  strong  relation  of 
the  "internal  secretions"  and  impotence  can  be  no  question,  thus  we. 
often  find  impotence  in  diabetes,  gout,  uremia,  and  to  quote  the 
words  of  Victor  Blum: 

I  give  here  again,  with  reserve,  my  opinion  that  in  these  forms  of  extinc- 
tion of  the  libido  in  diabetes  we  may  perhaps  have  to  do  with  an  insufficiency 
of  the  internal  secretion  of  the  genital  glands  and  other  glands  with  an  in- 
ternal secretion,  which  causes  on  the  one  hand  the  glycosuria  and  on  the 
other  the  effect  upon  the  psycho-sexual  center.  We  can  support  this  supposi- 
tion of  ours  by  experience  with  patients  with  affections  of  the  "blood  glands." 
So  for  example,  one  of  the  earliest  symptoms  in  acromegaly  is  impotence  with 
disappearance  of  the  sexual  impulse;  moreover,  this  form  of  inability  for 
coitus  is  one  of  the  commonest  symptom  of  Basedow's  disease.  In  Addison's 
disease  also  we  find  impotence  as  an  early  symptom  in  individual  cases  (von 
Neusser).  If  we  go  still  further,  we  might  cite  here  the  forms  of  impotence 
occurring  in  obesity  and  gout,  since  according  to  recent  investigations  these 
diseases  also  owe  their  origin  to  an  anomoly  of  the  glands  with  internal  secre- 
tions. Now,  the  relation  between  the  various  so-called  vascular  glands — the 
thyroid,  pancreas,  hypophysis,  suprarenal  capsules,  genital  glands,  testes  and 
prostate — are  so  intimate;  and  experimental  pathology  and  clinical  experi- 


SEXUAL    IMPOTENCE  237 

ence  teach  that  when  one  of  these  glands  becomes  affected  or  ceases  to  fun(!- 
tion,  the  other  glands  are  usually  also  influenced;  hence  we  must  express  the 
possibility  that  perhaps  the  impotence- — the  decline  or  extinction  of  the  libido 
—in  these  patients  is  due  to  an  alteration  of  the  glands  of  the  internal  secre- 
tion which  in  its  turn  affects  the  psycho-sexual  center. 

Pituitary  disease  has  been  observed  to  cause  impotence  (Lespi- 
nasse).  This  writer  also  calls  attention  of  the  close  relation  of  the 
internal  secretions  to  potency.  Excessive  masturbation  not  only  di- 
minishes the  libido  but  also  has  a  decided  injurious  effect  on  the 
other  functions  as  will  be  referred  to  again.  Alcohol  in  small  quan- 
tities stimulates  the  libido,  whereas  in  large  quantities,  it  has  a 
deadening  effect.  Aphrodisiac  drugs  must  also  be  included  as  di- 
minishing the  sexual  desire,  particularly  morphine,  cocaine,  arsenic, 
chloral,  the  bromides  and  potassium  nitrate.  Prolonged  continence, 
whether  from  fear  from  contracting  venereal  diseases,  for  moral  rea- 
sons or  where  the  nature  of  one's  business  is  such  preventing  the 
indulgence  in  the  act,  may  in  time  result  in  atony  to  some  degree 
of  the  sexual  centers,  which  has  the  effect  in  reducing  the  libido. 
Vecki  says:  ''If  coition,  however,  were  to  be  accomplished  only 
when  a  woman  is  to  be  impregnated,  then  most  men  would  become 
impotent  from  continence,  and  a  great  many  would  become  insane." 
Asexualization,  "anandria,"  is  where  there  is  a  total  absence  of  the 
sexual  desire.  This  may  occur  in  inveterate  masturbators  produc- 
ing a  paralysis  of  the  sexual  function.  Partial  or  complete  extinc- 
tion of  the  libido  is  sometimes  seen  in  individuals  extremely  absorbed 
in  intellectual  pursuits,  especially  mathematicians;  this  however,  is 
purely  psychic  and  usually  temporary. 

b.  Changes  in  the  erectile  faculty.  The  normal  erection  being 
one  of  the  important  factors  in  the  act  of  sexual  intercourse,  any 
interference  with  its  physiological  mechanism,  will  not  only  have  a 
decided  depressing  effect  on  a  patient,  but  is  one  of  the  first  things 
that  will  prompt  him  to  seek  professional  advice.  Erections  can  be 
effected  by  (1)  from  the  brain,  by  which  impulses  are  sent  to  the 
erectile  center  which  however,  is  not  controlled  by  the  will  alone, 
since  impressions  of  a  sexual  nature  must  exist,  emanating  from  the 
organs  of  the  senses,  chiefly  the  organs  of  sight,  touch  and  smell. 

(2)  By  direct  stimulation  of  the  genito-spinal  center  in  the   cord. 

(3)  From  impulses  emanating  from  the  periphery,  namely  by  means 
of  tactile  stimulations  of  the  genitals;  irritation  of  the  posterior 
urethra  and  prostate  from  massage  or  from  the  use  of  catheters  or 


238  HERBERT    SCHOENRICH 

irrigations;  pressure  of  a  full  bladder  upon  the  nervi  erigentes  and 
parietal  tension  of  the  filled  seminal  vesicles.  Erections  are  also 
subject  to  inhibitory  influences  coming  from  either  the  brain  as 
fear,  fright,  anxious  feelings,  etc.,  or,  from  the  periphery  as  pain, 
uncomfortable  sensations  around  the  genitals,  etc.  Based  on  this 
classification,  complete  or  partial  loss  of  the  erectile  power  as  a  cause 
of  impotence,  may  be  due  to  (1)  when  stimuli  reaching  the  erectile 
center  are  not  sufficiently  intense.  (2)  When  the  sensitiveness  of 
the  genito-spinal  center  is  lessened.  (3)  When  the  inhibitory  in- 
fluences, governing  the  erectile  center  predominate.  Possibly  the 
foremost  causes  contributing  to  the  failure  for  the  erectile  reflexes  to 
functionate  is  masturbation  and  sexual  abuses.  In  masturbators,  it 
has  been  observed,  that  the  first  symptom  is  in  the  break  of  har- 
mony between  the  two  centers  of  erection  and  ejaculation,  the  ejacu- 
lations occurring  prematurely;  while  in  the  case  of  sexual  abuses, 
the  erection  will  be  on  the  decHne  before  changes  are  observed  in 
the  ejaculations.  Abnormal  sexual  satisfaction,  especially  when  in- 
dulged in  excessivel}'-  may  act  as  a  hyperstimulation  causing  an  early 
decHne  of  the  erectile  power.  Perverse  sexual  desires  and  the  psy- 
chopathia,  I  will  but  mention  here  as  a  cause  of  impotence,  since 
this  subject  is  too  broad  and  further  discussion  thereof  would  be 
beyond  the  object  of  this  paper.  Diseases  of  the  central  and  periph- 
eral nerve  apparatus  may  act  as  an  etiological  factor  of  defective 
erections  but  here  as  in  the  case  of  the  diseases  that  diminish  the 
libido,  more  attention  must  necessarily  be  devoted  to  the  fife-threat- 
ening malady.  However,  I  will  at  least  mention,  that  tabes  and 
lues  may  affect  the  sexual  center,  sometime  temporarily  increasing 
the  desire  (satyriasis)  or  diminishing  it,  at  their  onset.  This  fact 
may  aid  one  in  his  diagnosis.  When  the  inhibitory  influences  out- 
weigh the  stimufi  causing  erection,  we  have  virtuafiy  a  psychic 
impotence.  For  instance,  a  fixed  idea  that  the  sexual  power  will 
fail  with  some  particular  party;  a  guilty  conscience  of  ha-\dng  mas- 
turbated too  excessively  in  youth,  whether  in  fact  or  imaginary, 
laboring  under  the  impression  that  all  sexual  energy  had  thus  been 
completely  exhausted;  fear  of  conti'acting  venereal  disease;  the 
idea  of  never  having  been  cured  of  a  venereal  infection ;  the  fear  of 
infecting  or  impregnating  others.  The  term  "relative  impotence" 
is  appfied  to  a  condition  where  a  man  is  sexually  attracted  to  onty 
a  certain  class  of  women,  yet  with  others  remains  impotent,  occa- 
sionally even  with  his  own  wife.     When  the  excitabifity  of  the  periph- 


SEXUAL    IMPOTENCE  239 

eral  nerve  endings  is  diminished,  the  stimuh  reaching  the  erectile 
center  are  obviously  mitigated.  This  is  "atonic  impotence"  and 
may  manifest  itself  either  by  the  absence  of  erection  without  undi- 
minished Hbido,  and  with  ejaculation;  or,  where  the  erection  is  so 
weak  or  of  only  short  duration,  that  it  depends  upon  the  excitability 
and  resisting  power  of  the  ejaculatory  center  whether  a  retarded  or 
a  precipitate  ejaculation  results.  Pathological  changes  in  the  pos- 
terior urethra  are  responsible  in  a  number  of  cases  for  interference 
with  potentia  coeundi.  For  when  we  bear  in  mind  the  anatomy  of 
the  posterior  urethra  and  prostate,  their  vascularity  and  rich  nerve 
supply,  one  can  readily  understand  that  inflammations  thereof, 
may  result  in  a  temporary  or  permanent  congestion,  causing  on  the 
one  hand  a  hyperaesthesia  of  the  urethra  which  acts  as  a  constant 
irritant  to  the  erectile  and  ejaculatory  center,  and  on  the  other  hand, 
an  anaesthesia,  which  in  an  degree  obtunds  the  stimuli  to  the  genito- 
spinal  center,  producing  an  atonic  impotence.  Such  inflammations 
may  be  brought  on  by  gonorrhea,  or  other  infections  or  the  result 
of  such  infections;  also  from  instrumentation,  masturbation,  coitus 
interruptus,  etc.  The  endoscopic  pictures  reveal  a  congestion  of  the 
mucous  membrane,  a  swollen  and  sensitive  verumontanum  with 
congestion  of  the  surrounding  mucous  membrane  and  which  bleed 
easily.  Clinical  symptoms  in  such  cases  will  be  in  the  form  of  func- 
tional disturbances  of  urination,  polyuria,  painful  micurition,  uneasi- 
ness etc.,  and  accompanied  frequently  in  severe  cases  by  the  symp- 
tom-complex of  neurasthenia. 

(3)  Changes  in  the  ejaculatory  function.  Although  the  center 
of  ejaculation  is  independent  from  the  erectile  center,  it  is  located 
close  by  in  the  spinal  cord,  in  the  region  of  the  fourth  lumbar  verte- 
bra (Budge),  and  subject,  in  a  great  extent,  to  the  same  influences 
as  the  erectile  center.  The  excitability  of  the  ejaculatory  center  is 
determined  by  the  fullness  of  the  seminal  vesicles,  the  intensity  of 
the  sexual  excitement  and  the  amount  of  the  peripheral  stimula- 
tions; and  the  center  may  be  stimulated  by  impulses  coming  from 
either  the  latter  source,  as  tactile  sensations  of  the  genitals,  or,  from 
the  brain,  as  seen  in  nocturnal  pollutions,  and  in  the  waking  state, 
by  means  of  erotic  impressions,  when  of  sufficient  intensity.  When 
there  is  an  increased  excitation  of  the  ejaculatory  center,  we  have 
a  condition  known  as  ''Ejaculatio  praecox,"  which  constitutes  a 
large  proportion  of  the  sexually  impotent.  The  pathogenisis  of 
which  two  forms  are  recognized  is  briefly  explained  as  follows :  First 


240  HERBERT    SCHOENRICH 

form,  produced  by  abnormally  strong  stimulations  of  the  ejaculatory 
center  and  more  of  a  physiological  phenomenon  usually  occurring 
in  healthy  men,  and  where  the  ejaculation  is  followed  by  no  bad 
after  effects  such  as  depression  and  neurasthenic  sj^mptoms.  For 
instance  in  amorous  subjects,  after  a  rather  prolonged  abstinence, 
the  strong  psychic  impulse  by  reason  of  the  lustful  impression  of  a 
nude  woman  and  accompanied  by  further  stimulations  of  the  center 
from  impulses  due  to  the  friction  in  the  vagina,  readilj^  explains 
the  possibility  of  a  premature  ejaculation.  This  form  of  impotence 
is  largely  psychic  and  the  prognosis  favorable.  Second  form,  that 
due  to  an  abnormal  irritabihty,  or  better,  a  primary  hyperexcita- 
bility  of  that  center,  referred  to  by  some  writers  as  "Impotence 
from  irritable  weakness."  Here  the  patient  often  suffers  the  symp- 
tom-complex of  sexual  neurasthenia,  the  ejaculation  is  followed  by 
extreme  depression  with  frequently  a  burning  pain  in  the  urethra, 
moreover,  he  becomes  highly  nervous  and  irritable.  The  penis 
will  not  become  fully  erect  before  the  ejaculation  sets  in,  and  if  the 
condition  is  neglected,  the  erection  will  become  still  more  deficient, 
and  finally,  even  the  reading  of  pornographic  literature,  etc.,  is  apt 
to  bring  on  an  ejaculation.  The  principal  causes  attributable  to 
this  condition  are  masturbation,  coitus  interruptus,  abnormal  sex- 
ual abuse,  which  also  tend  to  produce  a  congestion  of  the  posterior 
urethra,  in  consequence  whereby  an  added  more  or  less  permanent 
peripheral  stimulation  of  the  reflex  centers  is  manifested.  The  pres- 
ence of  this  congestion  is  easily  ascertainable  by  means  of  the  endo- 
scope, or  the  irrigating  urethroscope,  which  instruments  I  may  add, 
are  indispensable  as  an  aid  in  diagnosing  some  of  the  cases  of  sexual 
impotence.  The  "irritable  weakness"  of  this  center  is  partly  ex- 
plained in  so  far  that  the  psychic  inhibitory  influences  which  serve 
to  regulate  the  reflex  center  are  willfully  laid  aside  or  abused;  thus, 
masturbators  are  anxious  to  hurriedly  accomplish  their  deed;  and  in 
coitus  interruptus,  the  inhibitions  are  misused. 

Closely  related  to  premature  ejaculations  are  involuntary  seminal 
emissions  which  first  manifest  themselves  at  puberty  as  a  purely  nor- 
mal physiological  phenomenon.  Wlien  such  emissions  occur  at  fre- 
quent intervals  and  are  followed  by  bad  after  effects  we  meet  with 
another  form  of  sexual  impotence.  What  constitutes  a  normal 
physiological  emission  and  a  pathological  pollution  there  is  no  fine 
line  of  demarcation,  since  men  differ  in   their   viriUty   and   what 


SEXUAL   IMPOTENCE  241 

would  constitute  physiological  emissions  in  some  men,  in  other  indi- 
viduals, would  be  followed  by  distressing  symptoms.  Much  depends 
upon  the  individual's  sexual  need,  his  age,  temperament  and  other 
influences.  Pollutions  may  be  regarded  as  pathological  when  the 
patient  suffers  thereafter  with  depression,  irritability  and  nervous- 
ness; when  the  penis,  in  the  act  of  ejaculation,  does  not  become 
fully  erect;  when  ejaculations  occur  involuntarily,  at  abnormally 
frequent  intervals  and  out  of  all  proportion  to  the  individual's  ap- 
parent sexual  need.  A  greater  degree  of  irritability  of  the  sexual 
centers  shows  itself  in  the  form  of  diurnal  pollutions.  In  extreme 
cases,  the  most  trifling  erotic  excitement,  the  touching  of  a  female 
form,  the  reading  of  pornographic  literature,  even  the  most  obscene 
or  lustful  impression  is  apt  to  give  rise  to  a  pollution.  Later  the 
erections  and  voluptuous  feelings  cease,  the  patient  then  having 
reached  the  stage  of  advanced  sexual  impotence. 

It  is  well  to  bear  in  mind  that  a  condition  of  false  spermatorrhea 
may  exist  in  apparently  healthy  individuals,  this  manifests  itself 
by  the  appearance  at  the  meatus  of  a  drop  of  seminal  fluid  or  pro- 
static secretion  following  the  act  of  defecation,  particularly  where 
there  has  been  straining  at  stool.  As  this  is  of  such  frequent  occur- 
rence in  otherwise  healthy  individuals  and  may  continue  for  such  a 
long  period  of  time  without  giving  rise  to  any  further  untoward 
symptoms,  it  may  be  looked  upon  as  of  not  very  serious  import, 
but  to  the  individual  thus  affected  it  frequently  gives  rise  to  the 
most  depressing  mental  perturbation  and  its  psychic  effect  thus  has 
an  unfavorable  influence. 

The  conditions  responsible  for  these  abnormal  seminal  losses  are 
briefly:  Loss  of  muscular  tone  of  the  ejaculatory  ducts  at  their  open- 
ing in  the  posterior  urethra;  inflammation  or  congestion  of  the  pos- 
terior urethra,  in  whole  or  part,  acting  as  a  peripheral  stimulation. 
As  the  exciting  cause  of  these  pathological  changes  are  the  following  : 
Abuse  of  local  treatment  of  the  posterior  urethra;  result  of  acute  or 
chronic  gonorrhea;  phimosis;  excessive  masturbation,  particularly  in 
the  adolescense;  an  exaggerated  libido,  frequently  accompanying  an 
inherited  nervous  weakness,  predisposes  to  pollutions,  spermatorrhea 
and  impotence.  Intense  emotional  excitement  and  intellectual 
overstrain  can  irritate  the  central  nervous  organs  sufficiently  to 
cause  pollutions.  Lallemand  calls  attention  that  conditions  of  the 
rectum  (piles,  fissures,  etc.)  have  had  effect  on  the  genital  centers. 


242  HERBERT  SCHOENRICH 


TREATMENT 


The  treatment  includes  prophj-laxis  and  curative. 

Prophylaxis  treatment  would  naturally  consist  in  the  instruction 
of  the  individual  to  avoid  the  factors  heretofore  set  down  as  being 
the  exciting  causes,  biit  unfortunately'  this  condition,  when  in  its 
incipiency,  does  not  make  a  sufficient  impression  on  most  patients 
to  prompt  them  to  seek  early  medical  advice  and  therefore  the  ma- 
jority of  cases  will  have  progressed  considerablj'-  before  they  come 
under  observation.  The  prime  essential  and  first  step  in  the  treat- 
ment consists  in  a  heart  to  heart  talk  with  the  patient  to  gain  his 
confidence,  to  elicit  the  exact  symptoms,  which  by  the  way  is  not 
always  an  easy  task,  the  duration  of  these  symptoms,  to  ascertain 
at  what  period,  if  any,  the  patient's  sexual  function  were  entirely 
normal  and  the  possible  existing  causes  of  the  sexual  weakness. 
The  close  relation  of  general  neurasthenia  and  sexual  debility  must 
be  borne  in  mind,  hence  the  treatment  of  impotence  must  be  largely 
along  the  same  lines  best  adapted  as  in  general  neurasthenia,  namely 
suggestive  therapeutics,  change  of  climate,  hydrotherapy,  tonics, 
hygienic,  etc.  If  the  impotence  is  due  to  some  mechanical  obstruc- 
tion in  the  genital  track,  these  must  be  corrected  by  proper  surgical 
intervention.  If  the  site  of  the  trouble  is  located  in  the  prostatic 
urethra,  curative  measures  to  this  region  may  be  instituted  through 
the  means  of  the  urethroscope,  such  treatment  usually  consists  of 
application  of  various  strengths  of  silver  nitrate,  amputation  of  the 
diseased  verumontanum,  opening  of  follicular  cysts,  etc. 

For  the  relief  of  congestions  and  its  accompanying  hyperaesthesia 
in  this  area,  the  use  of  large  sounds,  allowing  these  to  remain  in  citu 
for  five  to  fifteen  minutes  will  often  be  found  beneficial,  and  what  I 
have  observed  to  yield  favorable  results  is  the  use  of  the  electrical 
vibrator  in  conjunction  with  the  sound.  Among  other  therapeutic 
measures  to  be  mentioned  is  the  psycho phore  or  cooling  sound,  hot 
rectal  douches,  and  massage  of  the  prostate. 

As  far  as  drugs  are  concerned,  one  must  approach  this  part  of 
our  subject  with  a  degree  of  conservatism.  Here  we  must  choose 
between  the  stimulating  drugs  as  strychnine,  phosphorus,  and  the 
organic  preparations  as  testicular  extract,  lecithin,  etc.  These  have 
their  application  more  particularly  where  the  impotency  has  reached 
its  extreme  degree  and  not  where  we  are  dealing  with  a  hyperaes- 
thesia manifesting  itself  rather  in  premature  ejaculation,  emissions, 
than  feeble  erections.  Here  the  spinal  sedatives,  such  as  hyoscya- 
mus,  belladonna,  ergot  and  bromides  are  to  be  recommended. 


ALLEN   TREATMENT    OF   DIABETES  243 

THE  ALLEN  TREATMENT  OF  DIABETES^ 

By  Theodore  H.  Morrison,  M.D. 

Mercy  Hospital,  Baltimore,  Md. 

The  brilliant  work  of  Dr.  F.  M.  Allen  in  his  experimentations 
upon  animals,  has  not  only  changed  our  conception  of  diabetes  but 
has  also  established  a  more  radical  and  reliable  method  of  treat- 
ing patients  suffering  with  this  affection.  Diabetes  mellitus  may 
be  defined  as  a  disease  in  which  the  normal  utilization  of  carbohy- 
drates is  impaired,  in  consequence  of  which  glucose  is  excreted 
in  the  urine.  In  the  treatment  of  these  cases  we  may  safely  follow 
Joslin's  simple  rule,  that  is  to  consider  any  patient  a  diabetic  pre- 
senting sugar  in  the  urine  demonstrable  by  any  of  the  common  tests. 

Allen  produced  a  condition  in  animals  which  simulated  human 
diabetes  by  partial  pancreatectomy  with  preservation  of  the  pan- 
creatic duct,  so  as  to  avoid  atrophy  of  the  remainder  of  the  pancreas. 
According  to  the  degree  of  pancreatic  destruction,  the  intensity  of 
the  disease  could  be  made  to  vary  from  the  mildest  to  the  most 
severe  type.  The  dogs  in  whom  glycosuria  was  produced  in  this 
manner,  were  observed  to  fail  progressively  and  to  ultimately  die 
in  coma,  when  fed  liberally.  Those  that  were  starved  until  glyco- 
suria disappeared  and  were  then  placed  upon  a  low  diet  were  seen 
to  do  well  and  there  was  no  reappearance  of  glycosuria.  As  a 
direct  outcome  of  this  work  the  Allen  treatment  has  been  applied 
to  human  beings. 

It  may  be  briefly  stated  that  the  best  established  and  most  gen- 
erally accepted  theory  regarding  diabetes  is  that  this  affection  re- 
sults from  a  deficiency  of  the  internal  secretion  of  the  pancreas.  In 
the  majority  of  cases  there  is  a  weakness  of  the  pancreatic  function, 
which  may  be  broken  down  by  overwork  or  strengthened  by  rest. 
In  a  few  cases,  there  is  gross  destruction  of  pancreatic  tissue  by  in- 
fection or  otherwise  and  in  these,  cures  have  been  effected  by  sim- 
ple drainage  of  the  gall-bladder.  Miscroscopically,  changes  in  the 
Islands  of  Langerhans  are  found.     Allen  says,  for  practical  purposes, 

We  may  consider  that  diabetes  is  merely  the  weakness  of  a  bodily  function 
— namely,  the  function  of  assimilating  certain  foods.  It  may  be  compared 
with  indigestion.  A  weak  stomach  may  never  become  a  strong  stomach,  but 
there  is  no  cause  for  death  unless  the  patient  abuses  the  weak  organ.     The 

iRead  before  Mercy  Hospital  House  Staff  Medical  Society. 


244  THEODORE    H.    MORRISON 

possibility  and  perhaps  the  probability  exists  that  a  weak  pancreas  is  some- 
thing analagous.  Every  person  has  his  weak  point  and  ultimately  breaks 
down  at  some  one  point  rather  than  everywhere  simultaneously.  If  a  person 
overtaxes  a  weak  stomach,  the  resulting  distress  punishes  the  error  and  forces 
him  to  desist.  If  he  overtaxes  a  weak  pancreas  nothing  but  intelligence  can 
show  him  what  is  wrong." 

The  weakjpancreas  may  never  become  a  strong  organ  but  by  proper 
feeding  the  weakened  function  can  be  spared  and  strengthened. 

The  treatment  of  diabetes  should  be  carried  out  in  a  hospital. 
For  twenty -four  hours  after  admission  to  the  ward  the  patient  should 
be  kept  on  his  customary  diet  in  order  to  determine  the  severity  of 
the  disease.  The  patient  is  then  starved,  allowing  no  food  whatever 
except  black  coffee,  whiskey,  tea  and  clear  broths.  A  cup  of  black 
coffee  and  an  ounce  of  whiskey  is  given  every  two  hours  from  7  a.m. 
to  7  p.m.  Any  clear  broth  may  be  given  in  addition  to  the  coffee 
several  times  a  day.  The  patient  need  not  remain  in  bed  during 
the  fast  and  water  may  be  given  freely.  It  is  not  necessary  to  give 
alkalies  unless  acidosis  is  present.  After  the  urine  has  been  sugar 
free  from  twenty-four  to  forty-eight  hours,  150  grams  of  vegetables 
containing  5  per  cent  carbohydrates  are  added  to  the  diet.  These 
vegetables  should  be  boiled  in  three  changes  of  water  in  order  to 
reduce  the  carbohydrate  content.  Five  grams  of  carbohydrate  are 
added  daily  in  this  form  up  to  20  grams  and  then  5  grams  are  added 
every  other  day  passing  successively  through  the  5,  10  and  15  per 
cent  vegetables  until  glycosuria  appears.  When  the  urine  has  been 
sugar  free  for  two  days,  in  addition  to  vegetables,  twenty  grams  of 
protein  in  the  form  of  eggs  are  given  and  subsequently  15  grams  of 
protein  are  added  daily  until  the  patient  is  receiving  about  1  gram 
of  protein  per  kilogram  of  body  weight.  Fat  in  the  form  of  butter, 
cream,  olive  oil,  bacon,  etc.  is  cautiously  added  to  the  diet  and  grad- 
ually increased  in  quantity  until  the  patient  receives  about  30  to  40 
calories  per  kilogram  of  body  weight.  It  is  just  as  important  to  de- 
termine the  protein  and  fat  tolerance  as  it  is  to  estimate  that  of 
carbohydrate;  for  it  has  been  observed  that  patients  who  are  con- 
stantly sugar  free  on  a  given  diet  will  show  glycosuria  if  an  addi- 
tional quantity  of  fat  and  protein  are  added. 

The  appearance  of  sugar  in  the  urine  is  the  signal  for  instituting 
fast  days  until  the  urine  is  sugar  free  again.  The  previous  diet  of 
the  patient  may  at  once  be  resumed  except  for  the  ehmination  of 
half  of  the  carbohydrates,  or  the  original  course  of  treatment  maj'' 


ALLEN    TREATMENT   OF   DIABETES  245 

again  be  followed,  passing  through  the  different  stages  at  a  more 
rapid  rate.  The  original  fast  may  last  from  two  to  eight  days,  but 
usually  not  over  four  days.  There  are  no  contraindications  to  the 
fast  except,  perhaps  nausea,  vomiting,  and  great  prostration;  if  these 
symptoms  supervene  they  can  be  overcome  by  feeding,  and  then 
after  a  short  period  another  fast  can  be  undertaken  without  their 
reappearance.  Weekly  fast  days  following  this  plan  of  treatment 
should  be  recommended.  Any  patient  with  a  tolerance  for  less  than- 
20  grams  carbohydrate  should  fast  one  day  in  seven ;  between  20  and 
50  grams  upon  the  weekly  fast  day  5  per  cent  vegetables  plus  half  the 
usual  amount  of  protein  and  fat  are  allowed,  when  the  tolerance  is 
between  50  and  a  100  grams  carbohydrate,  the  10  and  15  per  cent 
vegetables  are  added  as  well.  If  the  tolerance  is  more  than  100 
grams,  upon  the  weekly  fast  day  the  carbohydrate  should  be  halved. 

The  treatment  as  outlined  is  the  plan  used  in  handling  mild  or 
moderatel}^  severe  cases.  Joslin  modifies  this  plan  in  severe,  long 
standing,  complicated  obese  and  acidosis  cases  as  follows:  Without 
otherwise  changing  their  habits  of  diet,  he  omits  fat,  and  after  two 
days  he  omits  protein,  then  the  carbohydrates  are  halved  daily 
until  the  patient  is  taking  10  grams  of  carbohydrates;  the  fast  is 
then  undertaken  and  the  remainder  of  the  course  of  treatment  is 
similar  to  the  method  already  described.  This  plan  of  preparing 
the  patient  for  the  starvation  period  greatly  minimizes  the  possi- 
bility of  the  occurrence  of  acidosis ;  and  in  the  cases  in  which  acidosis 
alreadj''  exists  the  source  of  acid  poisoning  is  removed.  In  those 
severe  cases  with  acidosis,  as  indicated  by  a  positive  acetone  and 
diacetic  acid  reaction  in  the  urine,  it  is  best  to  give  sodium  bicar- 
bonate in  two  drachm  doses  every  three  hours  for  a  few  days  during 
the  fasting  period.  Joslin  warns  against  the  prolonged  use  of  alka- 
lies, for  in  many  cases  an  acidosis  is  kept  up  by  such  a  procedure, 
the  acidosis  promptly  disappearing  upon  the  withdrawal  of  the 
alkali. 

In  order  to  economize  time,  the  little  book  of  Hill  and  Eckman, 
which  gives  a  clear  account  of  the  Allen  treatment  with  graduated 
diet  lists  which  can  be  easily  followed,  will  be  found  very  useful.  The 
tables  of  Locke  can  also  be  utilized  to  great  advantage  in  calculating 
food  values.  Hart's  Food  Scale  may  be  recommended  as  a  most 
useful  and  simple  apparatus  for  weighing  food. 

When  the  patient  leaves  the  hospital  he  must  be  impressed  with 
the  fact  that  he  is  not  cured  and  that  treatment  lasts  throughout  life. 


Diet  list  in  diabetes  following  the  Allen  treatment 
Quantity  of  food  and  starvation  days  to  be  indicated  especially  for  each  patient 


BROTHS 

joslin's  list  of  vegetables 

fatty  foods 

A 

ny  clear  soup 

Per  cent  of  Carbohydrates 

MEAT 

5% 
Lettuce 

15% 
Artichokes 

Olive  Oil 

Butter 

Any  Except  Liver 

Spinach 

Parsnips 

Protein,  3% 

("4.5%  Carbo-1 

Sauerkraut 

Canned 

Cream    {  Fat,  18% 

\     hydrates     j 

String  Beans 

Lima  Beans 

[Carbohydrates,  4% 

Celery 

20% 

Beefsteak 

Asparagus 

Potatoes 

Chee^e    /P''otein,  30%. 
(..nee.e    y^^^^  ^8% 

Raw  Beef 

Cucumbers 

Shell  Beans 

Lamb 

Brussels 

Baked  Beans 

Lamb  Chops 

Sprouts 

Green  Corn 

Brains 

Sorrel 

Boiled  Rice 

Sweetbreads 

Endive 

Boiled  Macaroni 

Ham 
Bacon 

Dandelion 

Greens 
Swiss  Chard 

BEVERAGES 

Chicken 

Turkey 

Sea  Kale 

Coffee 
Tea 

Squab 

Cauliflower 

Tomatoes 

Milk— Carbohyd 

rates,  5%;  Protein,  3.5%;  Fat,  4% 

Rhubarb 
Egg  Plants 

Buttermilk— Carbohydrates,  5%;  Protein,  3%;  Fat,  1% 

FISH 

joslin's  list  of  fruits 

Leeks 
.   Beet  Greens 

EGGS   IN    ANY    FORM 

Any  Except: 
(Carbohydrates) 

Per  cent  of  C 

arbohydrates 

Water  Cress 

Cabbage 

Radishes 

5% 

15% 

joslin's   LIST    OF  NUTS 

Roe,  2.5% 

%  Carbohydrates 

Caviare,  7.6% 

Pumpkins 
Kohl-Rabi 

Ripe  Olives 

Apricots 

5% 

< 

Clams,  1% 

(20%  Fat) 

Blueberries 

Butternut 

Crabs,  1% 

Broccoli 

Grape  Fruit 

Cherries 

Pignolias 

Oysters,  4% 
Mussels,  1% 

Vegetables 
Marrow 

10% 

Currants 
Raspberries 

10% 
Brazil  Nuts 

Unless  Special 

Huckleberries 

Black  Walnuts 

Permission 

Lemons 

Hickory 

10% 

Oranges 
Cranberries 

20% 

Pecans 

Rock 

Bluefish 

Bass 

Onions 
Squash 
Turnip 

Strawberries 
Blackberries 
Gooseberries 

Plums 
Bananas 

Filberts 

15% 
Almonds 

Haddock 

Carrots 

Walnuts  (English) 
Beechnuts 

Halibut 

Okra 

Peaches 

Pineapples 

Watermelon 

BREAD 

Mushrooms 

,                     . 

Trout 

Pistachios 

Lobster 

Beets 

Muffins         and 

Pine  Nuts 

Mackerel 

15% 

Bread    made 

20% 

Terrapin 

15% 

from    Lyster 

Peanuts 

Salmon 

Apples 

Diabetic  Flour 

40%, 

Sardines 

Green  Peas 

Pears 

&  Casoid  Flour 

Chestnuts 

246 


ALLEN  TREATMENT  OP  DIABETES  247 

Just  as  soon  as  he  becomes  indiscreet  and  oversteps  the  'imits  of 
his  tolerance  he  will  undo  to  a  large  extent  the  benefits  derived 
from  the  hospital  treatment.  He  should  be  taught  to  examine  his 
urine  for  sugar  every  two  or  three  days.  At  the  slightest  appear- 
ance of  sugar  he  should  report  his  condition  to  the  physician  and  a 
fast  day  must  be  instituted.  The  importance  of  keeping  close  watch 
over  the  diet  cannot  be  overestimated.  The  weekly  fast  days 
should  be  observed  as  described.  Dr.  Julius  Friedenwald  gives  his 
patients  a  diet  list,  as  illustrated,  erasing  such  articles  of  food  as  are 
contraindicated.  It  is  more  important  to  instruct  the  patient  to 
weigh  at  weekly  intervals  and  to  remain  below  his  original  weight 
than  it  is  to  advise  the  weighing  of  the  food.  Patients  should  be 
encouraged  to  take  long  vacations,  to  secure  abundance  of  sleep, 
to  avoid  physical  and  mental  labor,  to  shun  obesity  and  to  secure 
sufficient  exercise.  Exercise  is  of  great  benefit  to  these  patients; 
brief  courses  of  vigorous  exercise  after  meals  with  periods  of  rest  are 
more  beneficial  then  continuous  exertions. 

At  this  hospital  we  have  thus  far  treated  twenty-four  cases  of 
diabetes  according  to  the  Allen  plan.  All  were  rendered  sugar  free 
in  from  one  to  seven  days.  The  average  stay  in  the  hospital  was 
•fourteen  days.  As  far  as  can  be  learned,  all  have  been  kept  sugar 
free  with  the  exception  of  two  cases.  One  patient  after  having  been 
discharged  sugar  free  and  in  good  condtion  disregarded  all  dietary 
restrictions  and  finally  succumbed  to  the  disease.  The  other  was 
a  very  severe  case  with  marked  acidosis  and  diabetic  retinitis  who 
was  rendered  sugar  and  acid  free  after  a  week's  treatment.  Her 
tolerance  was  approximately  only  15  grams  carbohydrate,  40  grams 
protein  and  20  grams  fat.  The  slightest  increase  in  her  diet  pro- 
duces glycosuria  but  a  single  day's  fast  overcomes  this  condition. 

In  conclusion,  the  importance  of  this  plan  of  treatment  can  best 
be  emphasized  by  quoting  Joslin  who  says: 

"Fasting  and  a  low  diet  have  been  known,  but  it  is  fair  to  give  Allen  the 
credit  of  (1)  seeing  the  therapeutic  significance  of  inanition  upon  a  severe 
case  of  diabetes;  (2)  proving  upon  diabetic  dogs  that  prolonged  fasting  would 
render  them  sugar  free,  and  (3)  having  the  courage  of  his  convictions  and 
applying  this  principle  to  human  diabetes.  The  simplicity  of  the  method 
shows  its  worth,  and  that  it  is  safe  for  the  overwhelming  majority  of  patients 
is  attested  by  the  low  mortality  which  has  followed  its  application." 


248  CHAMBERS   MEMORIAL    FUND 

THE  CHAMBERS  MEMORIAL  FUND 


iV^iiijJ 


13.  NoRHAM  Gardens. 
Oxford. 


yLc^t^u.^^t^iyCy'^y^^ 


The  Chambers  ]\Iemoiial  Fund  closed  on  April  10,  1917,  with  a 
total  of  $1127.50.  This  sum  has  been  used  by  the  committee  to 
secure  the  following  permanent  memorials. 


CHAMBERS  MEMORIAL  FUND 


249 


A  portrait  of  Dr.  Chambers,  painted  by  Miss  Keller,  to  be  pre- 
sented to  the  Medical  and  Chirurgical  Faculty  of  Maryland,  and  to 
be  hung  in  their  building. 

A  bronze  portrait  medallion,  to  be  erected  in  the  operating  room 
of  the  Mercy  Hospital,  the  scene  of  Dr.  Chambers'  life  work. 

An  operating  table  for  the  Mercy  Hospital  operating  room. 

The  cost  of  collecting  the  fund  was  $85.42,  all  of  which  was  ex- 
pended for  printing  and  postage,  except  $7.00  for  clerical  assistance. 
The  committee  is  under  great  obligation  to  Miss  McCullough,  the 
college  secretary  for  her  zeal  and  industrj^  in  taking  care  of  prac- 
tically all  of  the  office  work  connected  with  the  collection. 

The  satisfactory  completion  of  this  Fund  within  the  fixed  time, 
is  a  source  of  gratification  to  the  members  of  the  committee,  who 
interpret  the  spontaneous  and  generous  response  of  the  Alumni  of 
the  College  of  Physicians  and  Surgeons  as  evidence  of  the  esteem 
in  which  they  hold  their  distinguished  fellow  alumnus,  and  the  suc- 
cess of  the  Fund  as  a  mark  of  appreciation  of  the  many  fine  quail 
ties  of  Dr.  Chambers,  by  all  his  friends. 

Below  we  print  a  list  of  the  contributors. 


Dr.  Charles  Franklin  Abbott 

Dr.  J.  T.  Abshire 

Dr.  L.  F.  Ankrim 

Dr.  W.  R.  Arnold 

Dr.  Emerson  W.  Ayars 

Dr.  John  Ayd 

Dr.  A.  W.  Adkins 

Dr.  A.  L.  Amicke 

Dr.  F.  S.  Arnold 

Dr.  Wm.  Allan 

Dr.  B.  T.  Baggott 

Dr.  Henry  F.  Buettner 

Dr.  John  J.  Bell 

Dr.  F.  C.  Bressler 

Dr.  Ignatius  P.  A.  Bryne 

Dr.  C.  B.  Barry 

Dr.  E.  A.  Bowerman 

Dr.  W.  P.  Bonar 

Dr.  Wilmer  Brinton 

Dr.  John  D.  Blake 

Dr.  Chas.  F.  Beake 

Dr.  Wm.  F.  Barry 

Dr.  Horace  M.  Brown 

Dr.  Frank  L.  Barne 


Dr.  H.  G.  Beck 
Dr.  J.  R.  Bemisderfer 
Dr.  Frank  Belville 
Dr.  B.  F.  Bartho 
Dr.  G.  M.  Bell 
Dr.  P.  Briscoe 
Dr.  J.  F.  R.  Brubaker 
Dr.  W.  Wayne  Babcock 
Dr.  O.  H.  Bobbitt 
Dr.  Lewis  Berlin 
Dr.  W.  S.  Blaisdell 
Dr.  L.  H.  Clark 
Dr.  J.  D.  Chason 
Dr.  L.  R.  Chaput 
Dr.  John  J.  Cloonan 
Dr.  Theodore  S.  Crosby 
Dr.  Wm.  Coppage 
Dr.  Jno.  W.  Coughlin 
Dr.  L.  M.  Campbell 
Dr.  R.  Garn  Clark 
Dr.  Albertus  Cotton 
Dr.  J.  B.  Colcord 
Dr.  C.  D.  Crist 
Dr.  M.  D.  Cohu 


250 


CHAMBERS  MEMORIAL  FUND 


Dr.  M.  A.  Carroll 
Dr.  A.  W.  Clark 
Dr.  Lawrence  Creighton 
Dr.  J.  Spencer  Callen 
Dr.  Orel  ChafTee 
Dr.  R.  B.  Cullers 
Dr.  A.  J.  Campbell 
Dr.  J.  Plumer  Cole 
Dr.  C.  Melvin  Coon 
Dr.  John  H.  Carman 
Dr.  Hugh  Dunn 
Dr.  James  C.  Doughty 
Dr.  Jas.  L.  Doughton 
Dr.  I.  C.  Dickson 
Dr.  R.  G.  Davis 
Dr.  L.  L.  Doane 
Dr.  Geo.  O.  Davis 
Dr.  James  J.  Donahue 
Dr.  W.  E.  Delaney 
Dr.  W.  O.  Elmer 
Dr.  J.  L.  Easton 
Dr.  Lancelot  Eby 
Dr.  A.  M.  Evans 
Dr.  Joseph  L  France 
Dr.  H.  Lee  Franks 
Dr.  P.  J.  Franghnan 
Dr.  H.  S.  Foringcr 
Dr.  Julius  Friedenwald 
Dr.  Edgar  Friedenwald 
Dr.  Harry  Friedenwald 
Dr.  Geo.  L.  Faucett 
Dr.  W.  S.  Foster 
Dr.  H.  K.  Fleckenstein 
Dr.  S.  J.  Fort 
Dr.  R.  K.  Foxwell 
Dr.  David  S.  Fisher 
Dr.  Frank  H.  Finley 
Dr.  L.  O.  Fox 
Dr.  L  A.  Flowers 
Dr.  Alfred  T.  Gundry 
Dr.  Cary  B.  Gamble,  Jr. 
Dr.  E.  T.  Greutzner 
Dr.  William  S.  Gardner 
Dr.  T.  K.  Galvin 
Dr.  H.  K.  Gorsuch 
Dr.  A.  C.  Gillis 
Dr.  C.  Garrabraut 
Dr.  Chas.  D.  Gordon 
Dr.  P.  B.  Goodwin 


Dr.  W.  J.  Hunt 

Dr.  F.  W.  Hill 

Dr.  John  J.  Heck 

Dr.  R.  E.  Lee  Hall 

Dr.  F.  W.  Hill 

Dr.  A.  H.  Hawkins 

Dr.  Woolford  Hinzman 

Dr.  James  S.  Hewson 

Dr.  Irvin  Hardy 

Dr.  A.  C.  Harrison 

Dr.  EUery  M.  Hetherington 

Dr.  J.  L.  Hassell 

Dr.  C.  T.  Horn 

Dr.  Jno.  F.  Hogan 

Dr.  G.  G.  Irwin 

Dr.  D.  B.  Jarrell 

Dr.  C.  Hampson  Jones 

Dr.  Harvey  Jack 

Dr.  Kenna  Jackson 

Dr.  J.  J.  Jenkins 

Dr.  H.  S.  Jarrett 

Dr.  J.  M.  Johnston 

Dr.  H.  H.  Johnson 

Dr.  Thos.  F.  Kennedy 

Dr.  Francis  E.  Knowles 

Dr.  Fritz  J.  Ivimzey 

Dr.  A.  O.  Kisner 

Dr.  Max  Kahn 

Dr.  N.  G.  Keirle 

Dr.  Bernard  V.  Kelly 

Dr.  Jas.  M.  Kennedy 

Dr.  Seeber  King 

Dr.  S.  J.  Kell 

Dr.  H.  C.  Knapp 

Dr.  Geo.  B.  Kline 

Dr.  D.  M.  Kipps 

Dr.  F.  X.  Kearney 

Dr.  G.  Milton  Linthicum 

Dr.  A.  F.  Larason 

Dr.  J.  W.  Ledbury 

Dr.  R.  R.  Lee 

Dr.  D.  J.  Long 

Dr.  A.  B.  Lyon 

Dr.  W.  J.  Leahy 

Dr.  G.  M.  Lit  singer 

Dr.  \Vm.  F.  Lockwood 

Dr.  Maurice  Lazenby 

Chaplain  Murphy,  Mercy  Hospital 

Dr.  T.  H.  Morrison 


CHAMBERS  MEMORIAL  FUND 


251 


Dr.  D.  C.  Mock 

Dr.  W.  S.  Richardson 

Dr.  C.  F.  Merrill 

Dr.  W.  B.  Rowe 

Dr.  J.  W.  Moose 

Dr.  A.  F.  Ries 

Dr.  Frank  M.  Moose 

Dr.  C.  W.  G.  Rohrer 

Dr.  Chas.  B.  Messerly 

Dr.  R.  V.  Shirley 

Dr.  Geo.  W.  Mitchell 

Dr.  Richard  Shea 

Dr.  R.  C.  MoUoy 

Dr.  Frank  Dyer  Sanger 

Dr.  F.  W.  Mayer 

Dr.  Jno.  G.  Stiefel 

Dr.  Leo.  P.  Musser 

Dr.  Wm.  R.  Stokes 

Dr.  Erwin  E.  Mayer 

Dr.  H.  G.  Steele 

Dr.  M.  D.  McCutcheon 

Dr.  H.  M.  Stewart 

Dr.  Frank  F.  McDede 

Dr.  Otto  Schaefer 

Dr.  J.  E.  Marschner 

Dr.  Samuel  Schmidt 

Dr.  Alexius  McGlannan 

Dr.  E.  P.  Smith 

Dr.  Standish  McCleary 

Dr.  H.  B.  Summerville 

Dr.  H.  B.  McDonnell 

Dr.  F.  Schavoir 

Dr.  W.  A.  McMillan 

Dr.  Edw.  W.  Spraguc 

Dr.  W.  Raymond  McKenzie 

Dr.  Wm.  C.  Stifler 

Dr.  D.  I.  McColley 

Dr.  Frank  Stemke 

Dr.  J.  C.  McAllister 

Dr.  Geo.  A.  Strauss 

Dr.  B.  McGlone 

Dr.  S.  Dana  Sutliff 

Dr.  Geo.  McLean 

Dr.  Franklin  H.  Seiss 

Dr.  H.  L.  Mahoney 

Dr.  L.  Gibbons  Smart 

Dr.  John  L.  May 

Dr.  Francis  J.  Snyder 

Dr.  C.  W.  Maxson 

Dr.  J.  Gorse  Simmons 

Dr.  J.  P.  Monroe 

Dr.  E.  J.  Summers 

Dr.  C.  S.  Neer 

Dr.  R.  Elmer  Schall 

Dr.  Emil  Novak 

Dr.  M.  W.  Savage 

Sir  William  Osier 

Dr.  J.  F.  Spearman 

Dr.  H.  M.  Orr 

Dr.  A.  B.  Shatto 

Dr.  S.  K.  Owens 

Dr.  B.  Holly  Smith 

Dr.  J.  G.  Palmer 

Dr.  W.  G.  Shaw 

Dr.  Herbert  W.  Perry 

Dr.  J.  M.  Scanland 

Dr.  A.  F.  Peterson 

Dr.  Harvey  B.  Stone 

Dr.  G.  R.  Post 

Dr.  E.  C.  Stuart 

Dr.  W.  D.  Pickering 

Dr.  Frederick  C.  Schumacher 

Dr.  J.  W.  Preston 

Capt.  W.  H.  Thearle,  M.  C.  U.  S. 

A, 

Dr.  A.  Palmisano 

Dr.  J.  W.  Tarter 

Dr.  D.  C.  Patterson 

Dr.  Wm.  J.  Todd 

Dr.  Louis  Rosenthal 

Dr.  B.  H.  Tadeusiak 

Dr.  W.  W.  Requardt 

Dr.  A.  L.  Tumbleson 

Dr.  E.  R.  Raymaley 

Dr.  D.  H.  Thornton 

Dr.  H.  A.  Rosenthal 

Dr.  Alfred  Ullman 

Dr.  R.  T.  Ramsey 

Dr.  Frank  Virdin 

Dr.  N.  T.  Raines 

Mrs.  A.  B.  Van  Vazah 

Dr.  A.  G.  Rytina 

Dr.  G.  L.  Viewig 

Dr.  Melvin  Rosenthal 

Dr.  J.  M.  Vilella 

Dr.  H.  L.  Rogers 

Dr.  C.  M.  Van  Poole 

Dr.  J.  M.  H.  Rowland 

Dr.  E.  Van  Hodd 

252 


CHAMBERS    MEMORIAL    FUND 


Mrs.  A.  B.  Van  Valzak 

Dr.  Chas.  IVI.  Vogel 

Major  W.  A.  Wickline,  M.  C.  U.  S. 

Dr.  J.  I.  Wallace 

Dr.  C.  W.  Whirting 

Mr.  H.  W.  Wheaton 

Dr.  Henry  Wandless 

Dr.  Jno.  C.  Wj^sor 

Dr.  John  Wade 

Dr.  C.  B.  W.  Wiseman 


Dr.  T.  V.  Williams 
Dr.  J.  Percy  Wade 
A.       Dr.  John  I.  Wiseman 
Dr.  F.  W.  Wilcox 
Dr.  Augustin  V.  Wendel 
Dr.  T.  R.  Williams 
Dr.  J.  O.  Williams 
Dr.  S.  J.  Waterworth 
Dr.  L.  B.  Young 


CONTRIBUTIONS  FROM  PHYSICIANS  IN  YORK  AND  YORK 
COUNTY,  PA. 

Snyder,  J.  F.,  York 
Stambaugh,  E.  S.,  Thomasville 
Ufielman,  H.  W.,  Windsor 
Wentz,  P.  N.,  York 


Falkenstine,  A.  N.,  Glen  Rock 

Hildebrand,  Chas.  G.  Loganville 

Hildebrand,  R.  A.,  Glen  Rock 

Hyson,  J.  M.,  Red  Lion 

Lutz,  J.  Fletcher,  Glenn  Rock 

Miller,  Joseph  S.,  York 

Park,  E.  R.,  York 

Roberts,  S.  J.,  Goldsboro 

Roth,  L.  A.,  Spring  Grove 

Sei  z,  Clyde  G.,  Glen  Rock 

Shatto,  A.  B.,  Yo  k 

Shirey,  B.  W.,  York 

Siehling,  J.  H.,  New  Freedom,  R.  D. 


Wertz,  F.  H.,  Hanover 
Williams,  L.  V.,  Mt.  Wolf 
Wise,  F.  Roman 
Yagle,  Geo.ge 
Wise,  F.  Roman,  York 
Yagle,  George,  Red  Lion 
Yagle,  James  L.,  New  Freedom 
Grove,  A.  M.,  York,  (in  memory  of 
his  father) 


STATEMENT  OF  THE  OWNERSHIP,  MANAGEMENT,  CIRCULATION. 

ETC.,  REQUIRED  BY  THE  ACT  OF  CONGRESS  OF 

AUGUST  24,   1912. 

Bulletin  of  University  of  Mai-yland  School  of  Medicine  and  College  of 
Physicians  and  Surgeons,  published  ten  times  per  annum  at  Baltimore, 
Md.,  for  October  1,  1916. 

Name  of  Editor,  Caleb  Winslow  for  Nathan  Winslow,  M.D.,  Calvert  and 
Saratoga  Streets,  Baltimore,  Md. 

Managing  Editor,  None. 

Business  Managers,  Randolph  Winslow,  M.D.,  J.  M.  H.  Rowland,  M.D.,  and 
W.  S.  Gardner,  M.D.,  Lombard  and  Greene  Streets,  Baltimore,  Md. 

Publisher,  The  University  of  Maryland  School  of  Medicine  and  College  of 
Physicians  and  Surgeons,  Calvert  and  Saratoga  Streets,  Baltimore,  Md. 

Owner,  The  University  of  Maryland  School  of  Medicine  and  College  of  Phy- 
sicians and  Surgeons,  Calvert  and  Saratoga  Streets,  Baltimore,  Md. 

Known  bondholder,  mortgagees,  and  other  security  holders,  holding  1  per 
'  cent  or  more  of  totSl  amount  of  bonds,  mortages,  or  other  securities. 
(If  there  are  none,  so  state).     None. 

Nathan  Winslow,  M.D. 
by  Caleb  Winslow 

Sworn  to  and  subscribed  before  me  this  ISth  day  of  March,  1917. 

ISeal]  Mary  Virginia  Ward,  Notary  Public. 

(My  commission  expires  June,   1918.) 


BULLETIN 

OF    THE 

University  of  Maryland  School  of  Medicine 

AND 

College  of  Physicians  and  Surgeons 


Publication  Committee 

Randolph    Winslow,  A.M.,  M.D.,  LL.D.  Wm.  S.  Gardneb,  M.D. 

J.  M.  H.  Rowland,  M.D. 

Nathan  \\  inslow,  A.M.,  M.D.,  Editor 

Associate  Editors 

Albert  H.  Carroll,  M.D.  .Andrew  C.  Gillis,  A.M.,  M.D. 

John  Evans,  M.D. 


The  Call  to  War 

No  one  can  truthfully  accuse  this  countiy  of  having  rushed  pre- 
cipitately into  war.  For  two  years  and  eight  months  we  have 
suffered  both  insult  and  injury,  which  we  have  patiently  endured 
hoping  that  we  would  not  be  drawn  into  the  vortex  of  conflict. 
Conditions  have  now  become  intolerable  and,  in  the  judgment  of 
the  President,  the  time  has  arrived  for  more  vigorous  action.  From 
a  medical  standpoint  this  means  that  for  each  million  of  soldiers 
placed  in  the  field,  12,000  medical  officers  must  be  supplied.  The 
navy  also  must  be  much  augmented  and  many  medical  men  from 
civil  life  must  become  officers  in  this  branch  of  the  service.  Ur- 
gent appeals  are  being  made  to  physicians  to  enter  either  the  regu- 
lar service  or  to  become  members  of  the  Medical  Reserve  Corps  of 
the  Army  and  Navy.  The  Navy,  being  the  first  line  of  defense, 
must  be  equipped  thoroughly;  and  the  Surgeon  General  of  the  Na\y 
is  now  appealing  to  the  medical  schools  to  graduate  those  of  the  senior 
class,  who  have  maintained  an  average  of  85  per  cent  during  the 
four  5^ears,  two  months  in  advance  of  the  usual  time,  in  order  that 
they  may  enter  the  service.  But,  notwithstanding  this  urgent 
need,  they  do  not  seem  able  to  dispense  with  red  tape  and  treat 
applicants  with  ordinary  consideration  and,  unless  this  attitude  is 
changed  at  once,  there  may  be  difficulty  in  securing  the  necessary 
volunteers.     The  Council  on  Medical  Education  of  the  American 

2.53 


254  EDITORIALS 

Medical  Association  thinks  it  is  permissible  to  graduate  men  with 
high  grades  earl}^,  if  they  wish  to  enter  military  service.  The 
Army  not  only  needs. many  additional  medical  officers  in  the  regu- 
lar army  but  wishes  to  have  25,000  in  the  Medical  Reserve  Corps 
The  age  limit  is  placed  at  55  years  but  it  is  probable  that  even  that 
would  be  waived  in  suitable  cases.  In  the  event  of  large  numbers 
of  men  being  called  to  serve,  the  younger  men  will  probably  be  the 
first  to  go,  and  it  has  seemed  good  to  the  Medical  and  Chirurgical 
Faculty  of  Maryland  to  try  to  protect  their  interests,  in  order  that 
when  they  return  to  civil  life  they  may  not  be  penalized  for  their 
patriotism.  In  order  to  do  this  blanks  are  being  printed  to  be  sent 
to  the  patients  of  the  medical  man  who  is  called  into  service.  It  is 
also  expected  that  the  substitute  physician  will  keep  an  account  of 
such  patients  and  will  pay  to  the  reserve  officer  33  per  cent  of  the 
revenue  derived  from  them,  and  will  mturn  the  patients  to  the 
physician  when  he  returns. 

The  following  resolution  has  been  approved  by  the  council  of  the 
Medical  and  Chirurgical  Faculty  of  Maryland. 

Resolved  that  the  Medical  and  Chirurgical  Faculty  of  Maryland  recog- 
nizes the  patriotism  of  those  members  of  the  medical  profession  resident  in 
Maryland  who  volunteer  for  the  service  of  the  United  States  government, 
and  in  appreciation  of  this  we  recommend  that  should  these  members  of  the 
profession  be  called  into  active  service,  the  doctors  who  shall  attend  their 
patients  should  turn  over  one-third  of  the  fees  collected  from  such  patients 
to  the  physician  in  active  service  or  to  his  family. 

The  University  of  Maryland  is  desirous  of  placing  all  its  resources 
at  the  service  of  the  Government.  In  order  to  accomplish  this 
we  call  upon  all  who  are,  or  have  been  connected  with  the  University 
or  the  institutions  which  have  been  incorporated  with  it  to  fill  in 
the  sheet  at  the  back  of  this  Bulletin  and  thus  indicate  the  work 
they  can  best  render,  and  are  willing  to  place  in  the  service  of  the 
Government.  Please  fill  in  the  blank  and  mail  immediately  to  Dr. 
J.  M.  H.  Rowland,  Dean. 


t-"  9i 

>ti 

cO 

P 

^. 

'^ 

^ 

e 

a 

0) 

3 

O 

c       1 

< 

1 

I  < 

C3       O 


^   ^ 


m 


o 

-c 

-n 

r/1 

<1 

«J 

C 

0) 

fa 

o 

C 

ffi 

CQ 
o 


.2     i=i 


O    S     W 


CO       Q 


o 

c 

w 

'"' 

!2; 

o 

hj 

;^ 

w 

o 

o 

>' 

f/; 

o 

§ 

o 

r/T" 

c 

M 

'S 

W 

.^ 

^ 

Si 

1— 1 

+j 

C/J 

Tl 

'^ 

c3 

PQ 

jC 

Qi 

i-J 

> 

<; 

o 

3 

1— 1 

rn 

C/J 

^ 

15 

o 

^ 

« 

r! 

Ph 

o 


^  2:  a  -a  ^ 


-t.     «      M     OS 


^   ^    - 

^^      .2       '^ 


S    «    o 


03    3  -a  'c  a 


O    W    £    Ph    W 


Qtf5-<^MC)      W«; 


a 

03 

^  2    ■ 

O 

S|l 

^   ca  .S 

rmy: 
Regu 
Militi 
Train 

^.  y  ^ 

<■ 

«    OS   -S 


BULLETIN 

OF  THE 

University  of  Maryland  School 
OF  Medicine 

AND 

College  of  Physicians  and 
Surgeons 

Successor  to  The  Hospital  Bulletin,  of  the  University  of  Maryland, 
Baltimore  Medical  College  News,  and  the  Journal  of  the  Alumni  Asso- 
ciation of  the  College  of  Physicians  and  Surgeons 

Vol.  I  MAY,  1917  No.  10 

BIRTH  INJURIES  OF  THE  SHOULDER' 

By  Astley  p.  G.  Ashhurst,  M.D. 

Surgeon  to  the  Episcopal  Hospital,  Philadelphia 

Since  the  time  of  Duchenne  (1872)  it  has  been  thought  that  these 
birth  injuries  consisted  in  a  lesion  of  the  nerves;  especially,  accord- 
ing to  Erb  (1874)  in  a  lesion  at  the  point  where  the  fifth  and  sixth 
Cervical  Roots  join  to  form  the  upper  trunk  of  the  brachial  plexus. 
And  it  was  thought  that  the  resulting  disability  was  due  to  a  paraly- 
sis of  the  muscles  which  receive  their  nerve  supply  through  this 
trunk;  and  in  particular  that  the  posterior  dislocation  or  subluxation 
of  the  shoulder  so  often  seen  in  these  cases  was  the  result  of  paralysis 
of  certain  muscles  or  groups  of  muscles  and  of  the  unopposed  action 
of  their  antagonists.  In  a  paper  read  before  the  Philadelphia  Academy 
of  Surgery,  in  October,  1910,  T.  Turner  Thomas  proposed  the  theory 
that  the  original  injury  was  not  nervous  but  involved  the  cap  ule 
of  the  shoulder  joint;  that  the  dislocation  was  produced  at  the  time 
of  birth;  and  that  the  pseudo-paralysis  was  the  result,  not  the  cause 
of  the  deformity  of  the  shoulder.  Nerve  involvement,  he  said,  was 
secondarj^,  the  nerves  being  caught  in  scar  tissue  which  resulted 
from  the  injury  to  the  shoulder  joint.     This  same  view  has  since 

'  Abstract  of  an  adress  delivered  by  invitation  at  a  meeting  of  the  Medical 
Society  of  the  University  of  Maryland,  March  21,  1917. 

255 


256  ASTLEY    P.    C.    ASHHURST 

been  supported  by  Lange,  but  is  strenuoush'  opposed  bj'-  certain 
surgeons  (among  others,  A.  S.  Taylor,  Sharpe,  and  Sever). 

Though  it  must  be  acknowledged  that  the  question  of  the  pathogene- 
sis is  not  definitely  settled,  two  facts  may  be  emphasized,  which  lend 
support  to  the  articular,  and  weaken  the  neurogenous  theory:  (1) 
certain  muscles  supplied  through  the  fifth  and  sixth  roots  habitually 
escape  damage,  viz.,  the  subscapularis  and  teres  major;  and  (2)  all 
the  muscles  which  are  weak  or  powerless  are  supplied  by  nerves 
passing  close  to  the  shoulder  joint  (suprascapular,  musculo-cutan- 
eous,  circumflex,  musculo-spiral) ;  while  those  muscles  which  are 
scarcely  ever  affected  are  supplied  by  nerves  whose  course  lies  far 
away  from  the  shoulder  joint  (anterior  thoracic,  subscapulars, 
median,  ulnar). 

It  is  necessary  to  treat  these  patients,  even  though  the  pathogen- 
esis is  uncertain;  and  it  is  therefore  worth  while  to  put  on  record  the 
results  of  treatment,  especially  if  from  these  it  is  possible  to  gain  a 
clearer  idea  of  the  causes  of  disability. 

The  principles  of  treatment  I  have  employed  hitherto  are  based 
on  the  idea  of  preventi7ig  deformity  in  those  patients  seen  soon  after 
birth,  and  of  correcting  deformity  in  those  seen  after  it  has  developed. 
If  deformity  is  prevented  the  apparent  paralysis,  seen  soon  after 
birth,  will  disappear  entirely  in  the  vast  majority  of  patients;  and 
even  if  deformity  has  developed  before  the  patients  are  seen,  correc- 
tion of  the  deformity  will  enable  formerly  badly  handicapped  mus- 
cles to  resume  nearly  normal  function. 

The  disability  which  these  patients  experience  arises  almost 
entirely  from  loss  of  supination  of  the  forearm  and  of  external  rota- 
tion of  the  humerus.  The  former  movement  is  produced  largely 
by  the  biceps,  the  latter  by  those  muscles  which  insert  into  the  greater 
tuberosity  of  the  humerus.  Though  the  biceps  may  be  weak  it  is 
seldom  if  ever  entirety  powerless,  and  when  the  internal  rotation  of 
the  arm  has  been  overcome,  and  function  of  the  biceps  becomes 
possible,  it  is  quick  to  develop.  As  long  as  the  humerus  remains 
in  internal  rotation  it  is  impossible  to  flex  the  elbow  without  mark- 
edly abducting  the  humerus  at  the  shoulder;  and  even  with  this 
awkward  movement  patients  are  frequently  unable  to  get  the  hand 
to  the  mouth. 

In  the  newborn  baby  the  arm  should  be  carried  in  a  sling  and  held 
forward,  not  allowed  to  dangle  at  the  side,  with  the  shoulder  in 
internal   rotation   and   the   elbow   extended.     Likewise,    after   the 


BIRTH   INJURIES   OF   THE    SHOULDER  257 

original  soreness  from  the  birth  trauma  passes  off,  massage  should 
be  employed,  and  especially  passive  movements  of  abduction  and 
external  rotation  at  the  shoulder  and  of  supination  in  the  forearm. 
In  infants  and  even  in  children  up  to  3  years  of  age,  posterior  dis- 
location of  the  humerus  should  be  reduced  bloodlessly  as  in  congeni- 
tal dislocations  of  the  hip,  and  the  arm  should  be  dressed  in  a  gypsum 
case  with  the  humerus  in  full  abduction  and  external  rotation,  and 
the  elbow  flexed.  This  position  should  be  maintained  at  least  for 
3  months;  usually  the  plaster  of  Paris  needs  to  be  renewed  at  the  end 
of  six  weeks. 

In  children  who  first  come  under  observation  when  more  than 
three  years  of  age,  bloodless  reduction  of  the  dislocation  is  not 
efficient,  and  open  reduction  should  be  done.  I  have  used  Kocher's 
method  of  exposure  of  the  shoulder  joint  (by  temporary  resection 
of  the  acromiom)  in  a  number  of  cases  and  find  it  very  efficient. 
The  tendon  of  the  contractured  subscapularis  muscle  is  divided, 
permitting  full  external  rotation,  and  the  overstretched  posterior 
capsule  and  tendons  of  the  supraspinatus,  infraspinatus  and  teres 
minor  muscles  are  shortened.  If  the  acromium  is  deformed  (T.  T. 
Thomas  lays  much  stress  on  a  downward  bending  of  the  acromion) 
some  of  it  must  be  excised  to  raise  its  tip  out  of  the  way  of  the  newly 
reduced  humerus.  Sometimes  the  pectoralis  major  tendon  must 
be  divided  (through  a  separate  incision)  to  permit  full  abduction  of 
the  shoulder.  Even  in  cases  in  which  no  dislocation  is  present,  the 
disability  from  muscular  contractures  may  be  overcome  satisfac- 
torily by  open  section  of  the  tendons  of  the  subscapularis  and  pec- 
toralis major.  Both  of  these  may  of  course  be  easily  reached  through 
the  classical  anterior  incision  (Langenbeck)  for  excision  of  the  shoul- 
der joint.  In  all  these  cases  the  arm  should  be  dressed  in  the  over- 
corrected  position  (full  abduction  and  external  rotation) — the 
"pitching"  position,  for  a  period  of  three  months. 


258  J.   G.   SKILLING 

THE    SURGICAL    TREATMENT    OF    GASTRIC    AND 
DUODENAL  ULCERS ^ 

By  J.  G.  Skilling 
Senior  Medical  Student,  1917 

The  old,  familiar  saying  that  ''Rome  was  not  built  in  a  clay" 
can  readily  be  applied  to  ulcers  of  the  stomach  and  intestine.  They 
do  not  form  and  perforate  all  in  the  same  day,  and  it  is  because  of 
their  persistent  chronicity  that  patients  usually  seek  aid  long  before 
the  ulcer  has  perforated  or  there  are  any  signs  of  perforation 

In  a  large  number  of  cases  of  gastric  and  duodenal  ulcer,  unless 
immediate  perforation  has  taken  place,  the  patient  does  not  reach 
the  surgeons'  hands  until  after  he  has  been  treated  by  probably 
half  a  dozen  medical  men  and  is  in  such  a  run  down,  weak  and 
emaciated  condition  that  he  is  a  bad  surgical  risk.  These  cases  no 
doubt  have  a  tendency  to  increase  the  mortality  from  gastroenteros- 
tomy and  enteroenterostomy  so  that  is  is  difficult  to  say  whether 
death  was  due  to  the  immediate  operation  or  not.  In  view  of  this 
fact,  the  mortality  from  these  operations  is  comparatively  low. 

EARLY   DEVELOPMENT   OF   DIAGNOSTIC    METHODS 

The  early  development  of  diagnostic  methods  was  divided  into 
four  definite  periods.  The  first  might  be  called  a  period  of  clinical 
assertion,  when  a  statement  was  made  but  not  proved.  If  the  man 
making  the  statement  was  sufficiently  distinguished  and  held  a 
responsible  or  important  position,  his  words  were  treated  with 
great  consideration,  and  passed  into  text  books  on  Medicine  and 
Surgery,  not  as  mere  assertions,  but  as  accepted  facts. 

Following  this  period  of  ''diagnostic  assertion,"  came  the  post- 
mortem period,  at  which  time  nothing  could  be  accepted  as  true 
which  could  not  be  demonstrated  at  the  autopsy  table.  This  was 
also  rather  uncertain  as  the  postmortem  does  not  necessarily  reveal 
the  disease  the  patient  suffered  from  during  life,  but  merely  the 
disease  from  which  he  died,  and  for  this  reason  nothing  could  be 
more  deceptive  than  postmortem  findings. 

After  the  postmortem  period  came  the  third,  or  experimental 
period,  during  which  time  well  trained  men  devoted  themselves  to 
research.  Nothing  was  believed  true  unless  it  had  been  proved  by 
experiments  on  dogs  or  other  animals. 

^  Read  before  the  Randolph  Winslow  Surgical  Society  at  the  University 
Hospital,  December  4,  1916. 


SURGICAL   TREATMENT   OF   GASTRIC    ULCERS  259 

The  "experimental"  together  with  the  other  two  periods  has 
been  more  or  less  of  a  forerunner  of  the  fourth,  or  "period  of  clin- 
ical research."  It  is  upon  clinical  research  that  the  most  valuable 
contributions  are  now  being  made  to  science.  The  X-ray  and  other 
means  of  sight  demonstration  have  brought  marvelous  aid  to  diag- 
nostic measures. 

CHARACTER    AND    FREQUENCY    OF    GASTRIC    AND    DUODENAL    ULCERS 

Up  to  December  31,  1913,  1841  cases  of  acute  and  chronic  ulcers 
of  the  stomach  and  duodenum  had  been  operated  on  in  the  Mayo 
Clinic.  Four  hundred  and  thirty-seven  of  these  ulcers  occurred  in 
females  and  1384  in  males.  Of  the  1841  cases,  636  occurred  in  the 
stomach  and  1205  in  the  duodenum.  So  that,  gastric  and  duodenal 
ulcers  occurring  in  males,  by  far  and  away  outnumber  those  occur- 
ring in  females. 

The  situation  of  the  pyloric  veins  is  the  determining  factor  in 
differentiating  ulceration  of  the  pyloric  end  of  the  stomach  from  that 
of  the  first  portion  of  the  duodenum.  Just  at  the  pylorus,  short, 
thick  veins  come  into  view  from  above  and  below,  and  pass  from 
behind  forward.  There  is  a  distinct  notch  at  the  points  of  emer- 
gence of  the  veins. 

The  last  three-fourths  inch  of  the  pyloric  end  of  the  stomach  is 
not  often  involed  in  ulcer.  The  common  seat  of  gastric  ulcer  is  on 
the  lesser  curvature,  and  usually  posterior.  As  a  rule,  the  ulcer  is 
usually  clean  cut,  with  a  hard,  grayish  base,  and  oval  in  shape. 
Frequently  marked  infiltration  into  the  outer  layers  of  muscularis 
takes  place  around  the  ulcer.  As  a  result,  protective  adhesions  are 
often  found,  which  bind  the  seat  of  ulcer  to  other  organs,  such  as 
the  pancreas  and  liver.  Occasionally  multiple  ulcers  may  be  found, 
but  these  are  quite  'uncommon.  However,  separate  ulcers  in  the 
stomach  and  duodenum  may  occur,  and  do  occur  in  about  5  per  cent 
of  the  cases. 

In  the  early  history  of  the  disease,  long  periods  of  remission  may 
occur,  during  which  time  the  patient  thinks  he  has  entirely  recov- 
ered. In  this  respect  these  remissions  simulate  the  history  of  ap- 
pendicitis and  gall  stone  disease,  as  the  recovery  from  each  subse- 
quent attack  is  supposed  to  be  a  cure.  If  these  cases  are  operated 
on  during  the  period  of  remission,  it  will  be  found  that  the  ulcer 
is  not  healed.  It  cannot  be  doubted  that  in  a  certain  number  of 
cases,  permanent  healing  of  chronic  ulcers  of  the  stomach  and  duo- 


260  J.    G.    SKILLING 

denum  by  non-operative  means  has  occurred.  But  the  patient 
with  ulcer  treated  medicall}^  is  in  far  greater  danger  of  death  from 
hemorrhage,  perforation,  obstruction,  or  cancerous  degeneration 
than  he  is  from  an  operation. 

Before  discussing  repair  of  intestinal  and  gastric  wounds  from 
perforating  ulcers,  it  would  be  well  to  give  a  brief  review  of  the 
histology  of  the  gastrointestinal  canal.  The  stomach,  small  and 
large  bowel  are  all  composed  of  four  coats, — serous,  muscular,  sub- 
mucous and  mucous.  The  serous  coat  is  outermost  and  in  contact 
with  the  peritoneum.  It  consists  of  a  network  of  fibrous  connective 
tissue,  the  free  surface  of  which  is  covered  by  a  thin  laj^er  of  flat 
endothelial  cells.  The  muscular  coat  consists  of  a  thick,  inner 
circular  and  a  thin  outer  longitudinal  layer.  The  histological  ar- 
rangement in  the  stomach  is  varied  by  a  third  layer  of  oblique 
fibers  derived  from  the  osephagus.  In  the  colon,  the  longitudinal 
muscle  fibers  are  collected  into  three  flat  bands  placed  on  the  mes- 
enteric anterior  and  inner  borders  of  the  large  intestine.  The 
submucous  coat  is  composed  of  loosely  united  connective  tissue 
bundles  and  elastic  fibers  and  small  clusters  of  fat  cells.  The 
mucous  coat  is  soft,  highly  vascular  and  covered  with  epithehmn 
which  varies  according  to  its  situation  in  the  digestive  tube.  In  it 
are  located  the  glandular  elements  which  take  part  in  the  digestive 
processes.  The  villi  peculiar  to  the  small  intestine  give  the  inner 
surface  a  velvety  appearance.  The  muscularis  mucosa  is  important 
because  of  its  rough  structure  which  enables  it  to  resist  the  tension 
of  the  stitches  in  gastric  and  intestinal  operations.  It  is  the  only 
portion  of  the  intestinal  wall  which  has  this  valuable  property. 
The  blood  vessels  of  the  stomach  and  small  intestine  are  located  in 
the  submucous  coat.  It  also  contains  a  plexus  of  nerve  fibers  and 
a  network  of  large  lymphatic  vessels.  The  lymph  vessels  in  the 
stomach  take  their  origin  in  the  mucous  membrane  as  blind  capil- 
laries and  descend  between  the  gland  follicles.  In  the  small  intes- 
tine the  lymph  vessels  begin  in  the  axis  of  the  villi. 

CAUSES    OF   FAILURE   TO    CURE 

According  to  Dr.  W.  J.  Mayo,  the  most  common  cause  of  failure 
to  cm*e  gastric  and  duodenal  ulcers  by  operation  is  that  the  patient 
did  not  have  the  ulcer,  but  did  have  the  operation. 

The  second  common  cause  of  failure  to  cure  is  the  formation  of 


StJHGlCAL   TREATMENT   OF   GASTRIC   ULCERS  261 

a  stitch  ulcer  which  is  due  to  the  use  of  continuous  silk  or  linen 
sutures.  Permanent  silk  or  linen  sutures  used  in  gastroenterostomies 
have  been  removed  as  long  as  three  years  after  they  had  been  put 
n.  Quite  often,  after  a  few  months,  the  infected  sutures  slough  out 
but  the  edges  of  the  gastroenterostomy  are  left  thickened  with  inter- 
posing scar  tissue  and  adhesions  of  the  upper  jejunum  to  the  trans- 
verse mesocolon  in  the  vicinity  of  the  gastroenterostomy  occur. 
In  such  a  case  the  patient  will  have  a  recurrence  of  all  the  symptoms 
of  the  original  ulcer.  The  large  majority  of  so  called  jejunal  ulcers 
are  in  reality  gastrojejunal  stitch  ulcers.  Because  of  deforming, 
scars,  adhesions,  etc.,  the  percentage  of  failures  to  cure  ulcers  is 
much  higher  in  cases  of  ulcer  of  the  stomach  than  of  the  duodenum. 
The  third  cause  of  failure  to  cure  gastric  and  duodenal  ulcers 
may  be  due  to  development  of  carcinoma  in  the  ulcer.  Ten  per  cent 
of  the  cases  operated  on  for  peptic  ulcer  by  Von  Eiselsberg  died  sub- 
sequently from  cancer  of  the  stomach.  Of  all  the  different  symptoms 
produced  by  ulcer,  hemorrhage  is  the  one  which  operation  most 
often  fails  to  cure.  Unless  hemorrhage  is  preceded  and  followed 
by  symptoms  of  ulcer  it  is  probable  that  the  hemorrhage  is  not  due 
to  an  ulcer  but  to  infectious  emboli  from  some  other  part  of  the 
body. 

SURGICAL   TREATMENT 

Long  since,  it  has  been  the  custom  among  surgeons  generally  to 
do  a  gastroenterostomy  in  cases  of  ulcer  of  the  stomach,  especially 
when  the  ulcer  is  located  near  the  pylorus.  This  is  the  operation 
preferred  by  Dr.  W.  J.  Mayo  today,  yet  among  a  great  many  sur- 
geons it  is  falling  into  disfavor.  Dr.  Mayo  has  had  great  success 
with  this  method  of  treatment  and  claims  that  gastrojejunostomy 
is  of  value,  not  only  as  an  operation  for  drainage,  but  that  it  also 
changes  the  physiology  of  the  stomach  and  brings  a  greater  measure 
of  relief  than  can  be  achieved  without  it.  In  suitable  cases,  he  is 
strongly  in  favor  of  excision  of  the  ulcer  but  in  addition  thinks 
gastrojejunostomy  should  be  done  also. 

'  It  is  probable  the  abuse  of  gastroenterostomy  rather  than  its 
proper  and  rational  application  which  has  brought  it  more  or  less 
into  disfavor.  It  is  a  well  known  fact  that  many  operations  are 
being  performed  by  surgeons  who  open  an  abdomen  expecting  to 
find  an  ulcer,  and  who,  failing  to  find  one,  can  think  of  nothing  else 
to  do  than  the  gastroenterostomy  which  they  had  decided  one  or 


262  J.    G.    SKILLING 

two  days  before  was  the  proper  procedure  necessary  in  that  par- 
ticular case. 

Gastrojejunostomy  is  found  to  be  a  most  satisfactory  operation 
in  cases  where  the  ulcer  is  located  in  the  duodenum  and  there  is 
actual  obstruction  to  that  portion  of  the  gut.  In  the  Mayo  Clinic 
very  good  results  are  obtained  Ijy  infolding  the  ulcer  with  fine  silk 
and  placing  one  or  two  sutures  in  such  a  manner  as  to  block  the 
pylorus  to  prevent  food  from  entering  the  ulcerated  area  during  the 
healing  period.  This  blockage  by  suture  is  not  expected  to  be 
permanent,  but  in  connection  with  permanent  obstruction  produced 
by  healing  of  the  ulcer  it  usually  serves  the  purpose  very  well.  This 
blockage  should  be  accomplished  by  more  efficient  means  if  there  is 
either  actual  or  potential  obstruction. 

When  the  ulcer  is  favorably  situated,  that  is,  where  it  can  easily 
be  gotten  at,  probably  the  best  surgical  procedure  is  excision.  Fol- 
lowing excision  it  is  sometimes  necessary  to  make  thorough  provision 
for  drainage  at  the  pylorus  by  means  of  Finney's  pyloroplasty, 
which  is  really  a  gastroduodenostomy  and  performed  as  follows: 

Thoroughly  free  the  first  portion  of  the  duodenum  and  pyloric 
end  of  the  stomach,  by  dividing  the  posterior  layer  of  peritoneum 
one  inch  to  the  right  side  of  the  duodenum.  This  step  is  known  as 
mobilization.  Insert  3  retractor  sutures  and  draw  upon  them. 
Suture  together  the  peritoneal  surface  of  the  duodenum  and  the  peri- 
toneal surface  of  the  stomach  along  its  greater  curvature,  as  far  pos- 
terior as  possible.  Then  insert  an  anterior  row  of  mattress  sutures, 
but  do  not  tie  them  yet.  Make  a  horseshoe  shaped  incision,  arrest 
bleeding,  and  trim  off  the  redundant  mucous  membrane.  Insert  a 
continuous  catgut  suture  on  the  posterior  side  of  the  incision  and 
carry  it  through  all  the  coats.  Straighten  out  the  anterior  sutures 
and  tie  them. 

The  mortality  is  greater  than  from  gastroenterostomy  due  prob- 
ably to  the  necessity  of  separating  adhesions  and  setting  the  duo- 
denum free.  However  it  is  practiced  extensively  by  the  Mayos,  who 
prefer  it  to  Heineke-Mikulicz  pyloroplasty. 

Duodenal  and  gastric  ulcers  at  the  pyloric  end  of  the  stomach 
yield  equally  good  results  following  operation.  It  is  a  known  fact 
that  the  greater  the  distance  of  the  gastric  ulcer  from  the  pylorus, 
the  greater  the  technical  difficulties  in  its  operative  relief,  the  greater 
the  mortality,  and  on  account  of  the  deformities  which  may  be 
encountered,  the  less  certain  the  cure.     But  on  the  whole  95  per 


SURGICAL   TREATMENT    OF    GASTRIC    ULCERS  263 

cent  of  those  with  gastric  ulcer  will  be  cured  or  greatly  relieved  by 
operation.  Records  from  the  Mayo  Clinics  show  even  better  re- 
sults than  this  from  ulcers  in  the  duodenum.  Ninety-eight  per  cent 
of  the  patients  either  being  cured  or  greatly  relieved  by  operation. 

In  some  cases  after  operation  the  patients  show  definite  recur- 
rence of  symptoms  of  the  original  ulcer.  Most  of  these  are  due  to 
gastrojejunal  ulcers  in  the  suture  line  of  the  original  gastrojejunos- 
tomy due  to  sloughing  of  the  continuous  sutures  of  silk  or  linen. 
These  disastrous  results  can  be  eliminated  by  abandoning  the  con- 
tinuous silk  sutures  in  gastrojejunostomy  and  using  interrupted 
musculoperitoneal  sutures  of  fine  silk  with  continuous  chronic 
catgut  for  the  inner  rows. 

Of  comparative  recent  date  attention  has  been  called  to  the  use 
of  the  cautery  as  a  means  of  treating  gastric  ulcers.  Its  advocates, 
though  few  in  number  are  thoroughly  convinced  that  many  of  the 
dangers  following  excision  can  be  prevented  by  cauterization.  As 
a  rule  the  chief  difficulty  of  the  excision  method  of  treatment  is  not 
the  removal  of  the  ulcer,  but  rather  the  satisfactory  closure  of  the 
opening  thus  made,  except  when  located  high  on  the  lesser  curva- 
ture. Among  the  postoperative  dangers,  hemorrhage  is  one  of  the 
gravest  and  most  difficult  to  combat.  It  is  difficult  to  combat  for 
the  reason  that  it  may  occur  as  late  as  from  five  to  eight  da^'s  after 
operation.  The  condition  is  rather,  deceptive  in  that  the  bleeding 
is  not  profuse  but  persistent,  and  may  result  fatally.  Another  very 
important  point  to  consider  is  the  impairment  of  gastric  motility 
incident  to  interference  with  the  nerve  supply  in  extensive  excisions 
along  the  lesser  curvature.  Late  complications  may  also  be  due  to 
contracture  at  the  point  of  closure.  Bearing  these  grave  possi- 
bilities in  mind,  it  seems  obvious  that  the  actual  cautery  would  be 
a  satisfactory  method  of  dealing  with  many  superficial  ulcerations, 
iearly  epithelioma  and  certain  forms  of  carcinoma  not  only  by 
virtue  of  its  destruction  of  tissue  but  also  its  inhibition  of  hemorrhage. 
Before  appljdng  the  cautery,  the  portion  of  the  gastrohepatic  omen- 
tum in  the  region  of  the  ulcer  is  carefully  dissected  free  from  the 
lesser  curvature.  The  ulcer  is  carefully  palpated  and  with  the 
cautery  maintained  at  a  dull  heat,  the  point  is  slowly  carried  through 
the  ulcer  until  artificial  perforation  is  produced.  Moderate  burn- 
ing is  continued  until  the  actual  area  of  the  ulcer  is  entirely  destroyed. 
The  opening  is  then  closed  by  interrupted  sutures  of  chronicized 
catgut  reinforced  by  mattress  sutures  of  silk.     The  reflected  gastro- 


264  J.    G.    SKILLING 

hepatic  omentum  is  replaced  over  the  site  of  the  ulcer  and  fixed  by 
superficial  interrupted  sutures  of  fine  silk. 

The  main  features  accomplished  by  cautery  are  as  follows:  First: 
The  ulcer  is  destroyed,  and  with  it  any  early  malignancy.  Second: 
There  is  little  sacrifice  of  sound  gastric  tissue  and  secondary  contrac- 
tion is  therefore  minimized.  Third:  Early  or  late  hemorrhage  is 
almost  certainly  prevented.  Fourth:  The  operation  is  simple  and 
can  be  accomplished  with  speed  and  safety. 

When  perforation  of  a  gastric  or  duodenal  ulcer  has  occurred,  the 
cautery  is  of  much  less  value  than  excision.  The  tissue  involved  in 
the  ulcerative  process  should  be  excised  whenever  possible  before 
attempting  to  close  the  rent  in  the  stomach  wall.  This  removal  of 
diseased  tissue  not  only  facilitates  immediate  wound  repair  but 
also  lessens  the  tendency  to  recurrence.  Whenever  possible  after 
the  excision  of  an  ulcer,  the  suture  line  should  be  reinforced  by 
an  omental  graft  or  flap  as  the  danger  of  leakage  is  reduced  to  a 
minimum. 

Believing  that  the  ulcer  of  today  is  the  cancer  of  tomorrow,  it  is 
urged  that  in  every  suitable  case  the  ulcer  bearing  tissue  be  removed 
by  whatever  means  or  method  is  in  that  particular  instance  most 
safe  and  practical. 

In  closing,  let  me  state  that  Dr.  Wm.  J.  Mayo  who  has  done  more 
to  standardize  and  advance  surgical  prodecures  in  the  upper  abdo- 
men than  any  other  surgeon  living  or  dead,  thinks  nothing  in  the 
field  of  surgery  has  given  such  good  results  as  the  operative  treat- 
ment of  ulcer  of  the  stomach  and  duodenum. 

When  the  cancer  risk  is  considered  in  addition  to  disability  due 
to  ulcer  itself,  we  can  only  conclude  that  ulcer  in  its  chronic  form  is 
a  surgical  malady. 


DR.   JOHN  W.   CHAMBERS  265 

PRESENTATION  OF  A  PORTRAIT  OF  DR.  JOHN  W.  CHAM- 
BERS TO  THE  MEDICAL  AND  CHIRURGICAL  FACULTY 
OF  MARYLAND  BY  ALEXIUS  McGLANNAN,  M.D. 

On  January  21,  1917,  the  sudden  death  of  Dr.  John  W.  Chambers 
removed  from  the  Mercy  Hospital  a  famihar  presence,  a  good  friend 
and  the  senior  surgeon  of  the  staff. 

Since  1878,  when  he  graduated  at  the  College  of  Physicians  and 
Surgeons,  Dr.  Chambers  served  continuously  in  one  capacity  or 
another  as  a  member  of  the  staff  of  the  college  and  the  hospital. 
Beginning  as  resident  house  officer  in  the  Baltimore  City  Hospital, 
the  institution  which  later  on  became  the  Mercy  Hospital,  he 
successively  became  Prosector,  Demonstrator  and  Professor  of 
Anatomy,  Professor  of  Operative  and  Clinical  Surgery,  and  Pro- 
fessor of  Surgery  in  the  College;  Associate  Surgeon  and  Visiting 
Surgeon  to  the  Hospital.  For  many  years  he  was  the  dominant 
influence  in  the  work  of  the  hospital,  and  always  held  a  great  popu- 
larity with  the  students  of  the  College. 

The  alumni  all  recall  his  energy  and  enthusiasm,  especially  those 
who  came  under  him  during  the  early  nineties,  when  he  began  to 
teach  operative  and  clinical  surgery. 

Systematic  teaching  never  attracted  Dr.  Chambers.  His  course 
in  surgery  was  valuable  in  proportion  to  the  time  he  spent  at  the 
bedside  and  in  the  clinics.  His  dry  clinic  was  probably  his  best 
class. 

Diagnostic  signs  and  pathological  pictures,  as  they  could  be  rec- 
ognized or  indicated  by  physical  study  of  the  patients,  would  be 
pointed  out  as  they  showed  to  his  keen  observation.  The  discus- 
sion of  treatment  would  be  thorough  and  well  balanced,  the  result 
of  large  experience  and  sound  judgement. 

From  his  resident  days  Dr.  Chambers  was  an  untiring  student. 

His  reading  was  varied  and  serious.  In  medicine  he  followed 
the  English  school.  Hilton's  Rest  and  Pain  was  the  constant  com- 
panion and  mentor  of  his  period  of  hospital  residence.  Frequently 
he  quoted  from  it,  and  declared  that  he  had  committed  the  work 
to  memory  in  those  early  days. 

With  an  unfailing  memory  his  wide  reading,  sound  judgment, 
and  large  practice  brought  him  a  knowledge  of  disease  processes 
that  was  marvelous.  This  combination  of  qualifications  gave  him 
that  almost  intuitive  abihty  to  detect  and  discover  disease,  which 


266  DR.   JOHN  W.   CHAMBERS 

was  the  wonder  and  admiration  of  his  assistants  and  associates. 
The  internalists  and  the  specialists,  as  well  as  the  surgeons,  learned 
to  respect  his  insight  and  judgment. 

Outside  of  medicine,  Dr.  Chambers  has  wide  interests.  History, 
particularly  the  study  of  the  early  political  histor}^  of -the  United 
States,  was  a  favorite  recreation.  Alexander  Hamilton  and  Abra- 
ham Lincoln  appeared  to  be  the  heroes  of  his  reading. 

Political  questions  always  attracted  him  and  he  was  the  friend 
and  intimate  of  the  practical  politicians  as  well  as  of  the  theorists. 

Personally  Dr.  Chambers  was  a  loyal  and  warm  hearted  friend. 
His  kindness  to  the  young  men  in  medicine  is  a  by-word  in  Balti- 
more. Encouraging  and  instructive  to  any  one  in  difficulty,  toler- 
ant to  those  who  differed  from  him  in  opinion,  he  is  mourned  by  a 
host  of  friends  in  the  medical  profession  and  in  every  walk  of  life 

On  the  day  of  his  funeral  the  assembly  of  former  students  and 
associates  was  filled  with  the  desire  to  make  some  tangible  and 
lasting  tribute  to  his  memory.  The  project  was  taken  up  by  the 
Alumni  Association  of  the  College  of  Physicians  and  Surgeons  and 
Dr  Vogel,  the  president  of  the  Association,  appointed  a  committee 
to  collect  a  fund  and  secure  a  suitable  memorial. 

A  portrait  to  be  hung  in  our  Medical  Hall  of  Fame  at  once  sug- 
gested itself  as  the  most  fitting  tribute.  The  committee  has  been 
fortunate  in  securing  the  services  of  Miss  Kellar  for  making  the 
portrait,  because  she  has  not  only  brought  to  the  work  artistic  skill 
of  great  ability,  but  has  painted  into  the  picture  her  hearty  admira- 
tion for  an  old  friend. 

It  is  now  my  pleasant  duty  as  chairman  of  the  committee  to 
present  to  the  Medical  and  Chirurgical  Faculty  of  Maryland  in 
the  name  of  the  Alumni  Association  of  the  College  of  Phj^sicians 
and  Surgeons,  this  portrait  of  Dr.  Chambers. 

ACCEPTANCE   OF  THE  PORTRAIT  OF  DR.   CHAMBERS 
BY  RANDOLPH  WINSLOW,  M.D. 

On  behalf  of  the  Medical  and  Chirurgical  Facult}^  of  Maryland, 
and  at  the  request  of  the  President,  I  have  great  pleasure  in  accept- 
ing this  excellent  portrait  of  our  late  distinguished  friend  and  fellow, 
Doctor  John  Wesley  Chambers.  Too  often  in  the  past  when  those 
members  of  our  profession  who  have  borne  the  burden  and  heat  of 
the  day,  and  who  have  wrought  mightily  for  humanity,  have  fallen 


REPORT   OF   TREASURER  267 

asleep,  the  fragrance  of  their  memories  has  pervaded  our  assem- 
bHes  for  a  while,  but  this  gradually  has  become  less  and  less  distinct 
and  in  a  short  time  has  faded  out  completely;  so  that  even  their 
names  are  unknown  to  a  newer  generation.  It  is,  therefore,  a 
happy  custom  that  has  come  into  vogue  with  us,  in  recent  years, 
to  seek  to  perpetuate  the  memory  of  our  departed  fellow-members 
by  presenting  their  portraits  to  this  Faculty.  Already  the  faces  of 
many  of  our  honored  colleagues  look  down  upon  us  from  the  walls 
of  this  building;  thus  bringing  their  deeds  to  our  remembrance  and 
inciting  us  to  emulate  their  virtues.  Among  this  goodly  company 
we  shall  place  this  portrait  of  Doctor  Chambers,  believing  him  most 
worthy  of  a  niche  in  our  Hall  of  Fame. 

In  the  name  of  the  Faculty  I  thank  you  for  this  gift. 

CHAMBERS  MEMORIAL  FUND 

Supplementary  list  of  contributors  to  the  Chambers  Memorial 
Fund.     These  names  were  emitted  by  oversight: 

Dr.  Michael  Abrams  Dr.  D.  D.  V.  Stuart 

Dr.  Chas.  E.  Brack  Dr.  H.  G.  Stetson 

Dr.  Geo.  E.  Hardy  Dr.  W.  A.  Logan 

Dr.  W.  A.  Logan  Dr.  H.  L.  Stick 

Dr.  Benj.  McCleary  Dr.  Edward  N.  Brush 

^Dr.  Alex.  Mysels  Dr.  A.  0.  McKinley 
Dr.  Horace  Ripley 

REPORT  OF  CHARLES  MARKELL,  TREASURER 

Annual  Meeting,  January  8,  1917 
GENERAL  ENDOWMENT  FUND 

January  10,  1916,  Balance,  Central  Savings  Bank $2,128.29 

October    2,  1916,  City  of  Tacoma  Bonds  ($1000)  paid  at  maturity.  1,000.00 

January    1,  1917,  Interest  Central  Savings  Bank 28.30 

January    8,  1917,  Interest  on  bonds  to  date 410.00 

Total $3,566.59 

Deduct: 

March       6,  1916,  Bought  $2000  Consolidation  Coal  Co.  6%  Bonds 

at  104i  and  interest $2,101.67 

March       6,  1916,  Paid  premium  treasurer's  bond. ...  12.50 

October    2,  1916,  Paid  Colonial  Trust  Co.  box  rent..  5.00         $2,119.17 

January    8,  1917,  Balance,  Central  Savings  Bank $1,447.42 


268  REPORT   OF   TREASURER 

This  fund  consists  of: 

1      $500  University  of  Maryland  Regents  5%  bond $500.00 

1  $1000  Georgia  &  Alabama  5%  bond 1,000.00 

1  $1000  Georgia,  Caroline  &  Northern  5%  bond 1,000.00 

1  $1000  Omaha  &  Council  Bluffs  R.  &  B.  5%  bond 1,000.00 

1  $1000  Consolidation  Coal  Co.  6%  bond 1,000 .00 

2  $500  Consolidation  Coal  Co.  6%  bond 1,000 .00 

2  $1000  St.  Joseph  Ry.  Light,  Heat  &  Power,  5%  bonds 2,000.00 

1  $1000  Edison  Electric  Light  Co.  of  Los  Angeles  5%  bond 1,000.00 

Balance,  Central  Savings  Bank,  January  8,  1917 1,447.42 

$9,947,42 
FACULTY  OF  PHYSIC  FUND 

January  10,  1916,  Balance,  Central  Savings  Bank $1,743.74 

February  29,  1916,  Dr.  St.  Clair  Spruill  legacy 2,375.00 

March       9,  1916,  Principal,  Faculty  of  Physic  notes  paid 1,000.00 

October  22,  1916,  Anne  Arundel  County  Bond  paid  at  maturity. .  1,000.00 

October  14,  1916,  Principal,  Faculty  of  Physic  notes  paid 2,000.00 

January    1,  1917,  Interest,  Central  Savings  Bank 150.30 

January    8,  1917,  Subscriptions  to  date 75 .00 

January    8,  1917,  Interest  on  bonds  and  notes  to  date 1,052.56 

Total $9,396 .  60 

Deduct 

March     15,  1916,  Bought  two  $1000  West  Penn.  Power 

Co.  5  %  Bonds  at  97  and  interest $1,943.89 

October    6,  1916,  Bought  one  University  of  Maryland 

Regents  5%  bond  at  par 500.00 

November  1, 1916,  Express  charges  on  bonds .50  2,444.39 

January    8,  1917,  Balance,  Central  Savings  Bank $6,952.21 

This  fund  consists  of: 

3  $500  Newberg  Light,  Heat  &  Power  Co.  5%  bonds $1,500.00 

1  $1000  Georgia,  Carolina  &  Northern  5%  bonds 1,000.00 

5    $500  University  of  Maryland  Regents  5%  bonds 2,500 .00 

$1000  Public  Service  Corporation  of  N.  J.  5%  bond 1,000.00 

$1000  Minneapolis  G.  L.  1st  Gen.  Mortgage  5%  bond 1,000.00 

$1000  Edison  Electric  Co.  of  Los  Angeles  5%  bond 1,000.00 

$1000  Minneapolis  G.  L.  S.  Fund  5%  bond 1,000.00 

$1000  Fairmont  &  Clarksburg  Traction  5%  bond 1,000 .00 

$1000  Cons.  Gas  Co.  4§%  bond 980.00 

$1000  Louisville  Gas  &  Electric  6%  bond 990.00 

2  $1000  Omaha  &  Council  Bluffs  St.  Ry.  5%  bonds 1,940.00 

2  $1000  Cincinnati  Gas  Transportation  Co  5%  bonds 1,960.00 

2  $1000  Cumberland  County  Power  &  Light  Co.  5%  bonds 1,940.00 

2  $1000  West  Penn.  Power  Co.  5%  bonds 1,940.00 

Balance,  Central  Savings  Bank,  January  8,  1917 6,952.21 

$26,702.21 


REPORT   OP   TREASURER  269 

LEON  FRANK  FUND 

January  10,  1916,  Balance,  Central  Savings  Bank $104.89 

January    1,  1917,  Interest,  Central  Savings  Bank 2.45 

January    8,  1917,  Interest  on  bonds  to  date 125.00 

$232.34 
Deduct: 

June         10,  1917,  Paid  for  scholarship 125.00 

January    8,  1917,  Balance,  Central  Savings  Bank $107.34 

This  fund  consists  of: 

1    $500  Newburg  L.  H.  P  &.  5%  bond $500.00 

1  $1000  St.  Joseph  R.  L.  H.  &  P.  5%  bond 1,000.00 

1  $1000  Omaha  &  Council  Blufifs  R.  &  B.  5%  bond 1,000.00 

Balance,  Central  Savings  Bank,  January  8,  1917 107.34 

$2,607.34 
J.  C.  HEMMETER  FUND 

January  10,  1916,  Balance,  Central  Savings  Bank $1,373.92 

October    2,  1916,  Principal,  Faculty  of  Physic  note  paid 500.00 

January    1,  1917,  Interest,  Central  Savings  Bank 60.75 

January    8,  1917,  Interest  on  bonds  and  note  to  date 172.92 

January    8,  1917,  Balance,  Central  Savings  Bank $2,107.59 

This  fund  consists  of: 

1  $1000  Chicago  Ry.  5%  bond $1,000.00 

1  $1000  Chicago  City  Ry.  5%  bond 1,000.00 

1  $1000  Minneapolis  S.  Ry.  &  S.  P.  C.  R.  5%  bond 1,000,00 

Balance,  Central  Savings  Bank,  January  8,  1917 2,107.59 

$5000  Life  Insurance  Policy 

Total $5,107 ,  59 

CHARLES  FRICK  RESEARCH  FUND 

January  10,  1916,  Balance,  Central  Savings  Bank $748. 12 

January    1,  1917,  Interest  Central  Savings  Bank 29.80 

January    8,  1917,  Balance,  Central  Savings  Bank $777.92 

LAW  FUND 

January  10,  1916,  Balance,  Central  Savings  Bank $139. 13 

January    1,  1917,  Interest  Central  Savings  Bank 5.40 

January    8,  1917,  Balance,  Central  Savings  Bank $144.53 


270  REPORT    OF    TREASURER 

CHARLES  M.  HITCHCOCK  FUND 

January  10,  1916,  Balance,  Central  Savings  Bank $186.99 

January    1,  1917,  Interest  Central  Savings  Bank 4.90 

January    8,  1917,  Interest  on  bonds  to  date 250.00 

$441.89 
Deduct:  ^ 

June         10,  1916,  Paid  for  scholarships 250.00 

January    8,  1917,  Balance,  Central  Savings  Bank $191.89 

This  fund  consists  of: 

10  $500  University  of  Maryland  Regents  5%  bonds $5,000.00' 

Balance,  Central  Savings  Bank,  Jaeuary  8,  1917 191 .89 

$5,191.89 

CATHERINE  GIBSON  FUND 

January  10,  1916,  Balance,  Central  Savings  Bank $701.25 

January    1,  1917,  Interest  Central  Savings  Bank 28.50 

January    8,  1917,  Interest  on  bonds  to  date 50.08 

January    8,  1917,  Balance,  Central  Savings  Bank $779.83 

This  fund  consists  of: 

2  $500  University  of  Maryland  Regents  5%  bonds $1,000.00 

Balance,  Central  Savings  Bank,  January  8,  1917 779.83 

$1,779.83 

RANDOLPH  WINSLOW  FUND 

January  10,  1916,  Balance,  Central  Savings  Bank $66.66 

October  14,  1916,  Principal,  Faculty  of  Physic  note  paid 500.00 

January    1,  19l7,  Interest  Central  Savings  Bank 1 .32 

January    8,  1917,  Interest  on  bonds  to  date 122.92 

$690.90 
Deduct : 

June  10,  1916,  Paid  for  scholarship $125.00 

November  1,  1916,  Bought    one    $500    University    of 

Maryland  Regents  5%  bond  at  par $500.00  625.00 

January       8,  1917,  Balance,  Central  Savings  Bank $65.90 

This  fund  consists  of: 

5  $500  University  of  Maryland  Regents  5%  bonds $2,500.00 

Balance,  Central  Savings  Bank,  January  8,  1917 65.90 

$2,566.90 


REPORT    OF   TREASURER  271 

PHARMACY  FUND 

January  10,  1916,  Balance,  Central  Savings  Bank $17.73 

January    1,  1917,  Interest  Central  Savings  Bank .60 

January    8,  1917,  Balance,  Central  Savings  Bank $18.33 

DENTAL  FUND 

January  10,  1916,  Balance,  Central  Savings  Bank $5,33 

January    1,  1917,  Interest  Central  Savings  Bank .20 

January    8,  1917,  Balance,  Central  Savings  Bank $5.53 

TOTAL  PAR  OR  BOOK  VALUE  OF  ALL  FUNDS 

General  Endowment  Fund $9,947 .  42 

Faculty  of  Physic  Fund 26,702.21 

Leon  Frank  Fund 2,607.34 

J.  C.  Hemmeter  Fund 5,107.59 

Charles  Frick  Research  Fund 777 .92 

Law  Fund 144 .  53 

Charles  M.  Hitchcock  Fund 5,191 .89 

Catherine  Gibson  Fund 1,779.83 

Randolph  Winslow  Fund , 2,565.90 

Pharmacy  Fund 18.33 

Dental  Fund 5 .  53 

$54,848.49 


272  CORRESPONDENCE 

C0RR5]SP0NDENCE 

Braddock,  Pa.,  April  12,  1917. 
Dear  Doctor: 

An  invitation  with  my  compliments. 

Am  gynecologist  of  the  institution  and  President  of  the  Board  of  Managers 
of  the  Braddock  General  Hospital,  recently  reelected  for  my  fourth  term. 
Capacity  about  140  beds. 

Sincerely, 

W.  T.  Morgan, 
Univ.    of  Md.,  1884. 
[Invitation  enclosed  with  letter  of  Dr.  Morgan.] 

The  Board  of  Managers  of  the  Braddock  General  Hospital  cordially  invites 
you  to  be  present  at  the  Dedication  Services  of  the  New  Wing,  Thursday 
evening,  April  nineteenth  at  eight  o'clock  at  the  Hospital. 

You  are  also  invited  to  the  Graduating  Exercises  of  the  Class  of  1917, 
Friday  evening,  April  twentieth,  at  eight  o'clock,  Carnegie  Music  Hall. 

Reception  immediately  after  Dedication  Services. 

February  26,  1917. 
The  Registrar 

University  of  Maryland. 

Dear  Sir: 

The  November  Bulletin  of  the  University  of  Maryland  has  just  come 
to  hand  and  I  notice  amongst  the  editorial  notes  that  certificates  issued  by 
the  University  of  Maryland  to  graduates  of  the  Baltimore  Medical  College 
can  be  had  by  application  t  o  you. 

I  am  a  graduate  of  the  Baltimore  Medical  College,  class  1897,  and  prac- 
ticed as  a  medical  missionary  in  Brazil  for  a  number  of  years,  then  taking  the 
state  board  examination  of  West  Virginia  in  1903.  I  planned  to  settle  down, 
but  instead  was  appointed  to  the  Philippines  in  1905,  and  have  been  in  the 
service  of  the  Presbyterian  Medical  Mission  work  in  the  Philippines  for  11 
years.  Of  course  I  took  the  state  board  examination  for  the  Philippines  in 
1906. 

If  reference  is  required  for  the  sake  of  identification  Dr.  R.  W.  Love  of 
Moorefield,  W.  Va.  (also  a  B.  M.  C.  graduate)  could  furnish  the  same. 

Dr.  Jas.  Webster  of  Hancock,  Ind.,  (U.  of  Md.)  could  also  identify  me. 

I  am  also  well  known  to  Dr.  Justus  H.  Ehlers,  dentist.  North  CarroUton 
Avenue  (600  block)  Baltimore. 

Enclosed  find  $10.00  the  sum  mentioned  as  a  fee  for  the  issuing  of  the 
certificate. 

Thanking  you  for  the  Bulletin  and  hoping  to  hear  from  you  by  return 
mail,  I  am 

Yours  sincerely, 

James  Alexander  Graham,  M.D., 
Baltimore  Medical  College,  Qlass  of  1897. 


CORRESPONDENCE  273 

April,  7,  1917. 

Dr.  Nathan  Winslow,  Editor, 
Bulletin  of  the  University  of  Maryland  School  of  Medicine 
and  College  of  Physicians  and  Surgeons, 
Baltimore,  Md. 

My  Dear  Doctor: 

It  is  with  great  pleasure  that  I  read  each  month  the  Bulletin  which 
you  so  kindly  send  me.  I  thought  it  might  be  of  interest  to  my  former 
teachers  to  know  that  I  have  the  head  of  the  department  of  Urology  and 
Urological  Surgery  at  the  College  of  Medicine  of  the  University  of  Illinois, 
and  am  Secretary  and  Treasurer  of  the  Chicago  Urological  Society. 

Yours  most  sincerely, 

French  S.  Cary,  1906. 

Rio  Grande,  P.  R., 
February  15,  1917.  • 
Dr.  J.  M.  H.  Rowland,  Dean, 

University  of  Maryland  School  of  Medicine,  Baltimore,  Md. 

My  Dear  Dr.  Rowland: 

I  have  received  the  first  six  number  of  the  Bulletin  of  the  University 
OF  Maryland  School  of  Medicine  and  College  of  Physicians  and  Sur- 
geons, and  have  read  them  with  keen  interest.  The  Bulletin  brings  to 
my  memory  pleasant  recollections  of  my  college  days  in  Baltimore — the 
Monumental  City.  It  contains  much  valuable  contribution  to  medicine 
and  surgery,  helping  to  widen  one's  professional  knowledge  and  sphere. 

Shortly  after  my  arrival  in  Porto-Rico,  I  took  the  Medical  State  Board, 
and  passed  it  with  the  highest  percentage.  Since  then  I  have  been  prac- 
ticing in  this  town.  I  was  for  two  years  health  officer  of  the  sanitary  zone  of 
Rio-Grande  and  Loiza,  under  the  direction  of  the  Service  of  Sanitation, 
which  position  I  resigned.  I  am,  at  present,  inspector  of  municipal  health 
and  charities  in  this  municipality,  doing  general  practice,  especially  obstet- 
rical and  gynecological. 

On  November  3,  1914  I  was  elected  mayor  of  this  municipality,  tendering 
my  resignation  a  couple  of  months  after,  and  was  subsequently  elected  hon- 
orary president  of  the  local  board  of  the  Unionist  party.  This  party,  now 
in  power,  stands  for  independency  as  a  definite  solution  to  our  political  status 
— independency  under  the  protectorate  of  the  United  States.  It  calls  for  a 
system  of  self-government  as  a  transitory  measure  for  Porto-Ricans  to  show 
our  capability  to  govern  our  own  affairs  and  occupy  a  place  amongst  the 
American  republics. 

I  was  too  sorry  to  hear  of  the  death  of  Professor  Streett'j  it  affected  me 
greatly. 

I  am  enclosing  P.  O.  money-order  for  ten  dollars,  that  I  may  receive  the 
certificate  issued  to  graduates  of  the  B.  M.  C.  by  the  U.  of  M.,  and  send 
herewith,  on  a  slip  of  paper,  my  -whole  name,  as  it  appears  on  my  diploma. 

With  kindest  regards  to  my  old  professors  at  B.  M.  C,  and  wishing  you 


274  CORRESPONDENCE 

good  health  and  a  series  of  unbroken  successes  during  this  new  year,  I  remain, 

sincerely  yours, 

Louis  C.  Boneta,  M.D., 
1908,  U.  of  Md.  (B.  M.  C.) 

University  of  Maryland  Medical  Department,  Class  of  1912: 

Baltimore,  Md. 
April  1,  1917. 
My  Dear  Classmates:  In  accordance  with  our  pledge  on  eve  of  class  ban- 
quet, we  are  to  hold  the  first  class  reunion  in  this  city  May  31,  June  1  and  2  of 
this  year,  and  expect  a  splendid  representation  of  "1912." 

A  banquet,  theater  party  or  an  afternoon  down  the  bay,  and  clinics  at  the 
various  hospitals  will  be  arranged  and  you  are  expected  to  be  present. 

The  A.  M.  A.  meets  in  New  York  beginning  June  4,  special  railroad  rates 
will  be  given  from  this  city  and  many  of  us  will  likely  attend  these  meetings 
at  conclusion  of  the  reunion. 

May  I  count  on  you?  If  so  please  drop  a  line  at  once  and  inclose  a  check 
for  $5  to  defray  expenses. 

Fraternally, 

Edw.  S.  Johnson, 
1910  Eutaw  Place.  Secretary. 

April  24,  1917. 
Dr.  Chas.  E.  Brack, 
Baltimore,  Md. 

Dear  Dr.  Brack: 

Dr.  Alexander  Thomson,  a  graduate  of  the  P.  &  S.,  1908,  and  who  has  been 
associated  with  me  here  in  my  hospital  since  the  death  of  Dr.  Dorsey  in  1912, 
died  the  19th  inst.,  as  a  result  of  acute  dilatation  of  the  heart  following  an  opera- 
tion for  appendicitis.  He  attained  a  good  deal  of  prominence  in  his  practice 
here  and  was  one  of  the  most  popular  men  I  ever  knew.    His  age  was  45  years. 

Sincerly  Yours, 

M.   T.   Dalton. 


BULLETIN 

OF    THE 

University  of  Maryland  School  of  Medicine 

AND 

College  of  Physicians  and  Surgeons 


Publication  Committee 

Randolph    VYinslow,  A.M.,  M.D.,  LL.D.  Wu.  S.  Gardmbr.  M.D. 

J.  M.  H.  Rowland,  M.D. 

Nathan  Winslow,  A.M.,  M.D.,  Editor 

Associate  Editors 

Albert  H.  Carroll,  M.D.  .Andrew  C.  GiLLts,  A.M.,  M.D. 

John  Evans,  M.D. 


An  Interesting  Bit  of  History 

The  following  notice  is  copied  from  the  Bulletin  of  the  Medical 
and  Chirurgical  Facidty  of  Maryland,  April,  1917.  The  College  of 
Medicine  of  Maryland  founded  in  1807,  was  ordered  in  1812  to 
annex  faculties  of  divinity,  law,  and  the  arts  and  sciences  and  the 
four  faculties  to  form  an  University  to  be  known  as  the  University 
of  Maryland. 

COLLEGE  OF  MEDICINE  OF  MARYLAND 

The  legislature  of  this  state  have  passed,  at  their  last  session,  an  act  to 
establish  a  medical  school  in  Baltimore,  by  the  name  of  ''The  College  of 
Medicine  of  Maryland."  We  have  every  reason  to  believe,  that,  if  those 
who  are  entrusted  with  the  carrying  of  this  act  into  effect  will  exert  them- 
selves, this  institution  will  prove  of  material  benefit  to  the  city  of  Baltimore 
and  to  the  state  of  Maryland.  In  no  part  of  the  union  is  there  another  place, 
whose  local  advantages  are  superior  to  those  of  Baltimore,  for  the  encourage- 
ment of  such  a  seminary.  In  none  of  the  large  towns  to  the  southward  can 
the  important  science  of  anatomy  be  cultivated  for  any  great  portion  of  the 
year,  without  inconveniences  sufficient  to  damp  the  ardor  of  its  most  zealous 
votaries. 

In  Baltimore  the  continuance  of  cold  or  temperate  weather  enables  the 
dissector  to  pursue  his  investigations  for  at  least  si.x  months  in  the  year. 
Nor  is  the  climate  on  the  other  hand  so  chilling  as  to  preclude  the  botanist 
from  extending  his  researches.     Most  of  the  plants  of  warm  climates  will 

275 


276  EDITORIALS 

thrive  in  the  open  air  in  summer,  and  in  winter  they  may  be  protected  by 
artificial  warmth.  The  productions  of  colder  climates  are  not  unknown, 
and  in  the  shade  of  the  neighboring  woods  we  find  many  of  the  vegtables  that 
are  found  in  the  forests  of  Canada.  From  the  central  situation  of  Baltimore, 
in  the  heart  of  the  union,  connected  with  a  great  part  of  it  by  navigable 
waters,  or  by  roads  which  are  every  day  more  frequented,  it  cannot  fail  to 
be  an  eligible  residence  for  such  young  men  as  travel  from  home  to  complete 
their  education.  Here,  where  they  have  daily  opportunities  of  communica- 
tion with  their  places  of  residence,  and  frequent  occasions  of  meeting  with 
persons  to  whom  they  are  known,  they  will  be  in  a  degree  less  removed  from 
home,  than  if  they  were  where  these  circumstances  do  not  exist.  Baltimore 
may  also  boast  the  advantage  of  presenting  fewer  incentives  to  idleness  and 
dissipation  than  other  large  towns  upon  the  continent. 

With  respect  to  its  public  institutions,  there  are  several  that  may  be  ren- 
dered subservient  to  medical  instruction.  The  alms-house,  the  city  and 
marine  hospitals,  all  present  a  fimd  of  illustrations  of  the  doctrines  that  may 
be  delivered  in  the  college.  The  public  library  contains  no  inconsiderable 
collection  of  books  upon  medical  science,  to  which  any  one  may  have  access 
upon  paying  a  moderate  compensation.  To  those,  who  wish  to  perfect  them- 
selves in  other  branches  of  education,  an  opportunity  is  offered  in  two  other 
colleges,  where  in  the  sciences  are  cultivated  with  unabating  zeal.  The 
college  of  medicine  is  the  third  collegiate  institution  that  has  been  founded 
in  Baltimore;  so  that  we  may  now  justly  allow  this  city  a  fair  claim  to  be 
styled  an  university. 

In  framing  the  charter  of  the  college,  very  annple  privileges  have  been 
granted  to  it.  The  government  of  the  whole  is  vested  in  the  professors,  to- 
gether with  the  members  of  the  board  of  medical  examiners  for  this  state; 
who  are  jointly  styled  the  Regents  of  the  College  of  Medicine  of  Maryland. 
They  are  enabled  by  their  charter  to  hold  property  to  the  value  of  $30,000 
per  annum,  and  are  authorized  to  raise  $40,000  by  lottery.  They  are  author- 
ized to  appoint  the  professors  of  such  branches  of  medical  knowledge  as 
they  deem  necessary  to  be  taught,  and  also  to  appoint  lecturers  upon  those 
departments  of  science  which  are  indirectly  connected  with  medicine. 

The  zeal  of  the  present  members  of  the  college,  and  the  favour  with  which 
their  undertaking  has  been  received  by  the  citizens  of  Baltimore,  lead  us  to 
augur  well  of  their  success.  The  professors  of  anatomy  and  chemistry  have 
already  entered  upon  the  duties  of  their  office,  and  have  continued  to  lecture, 
since  the  commencement  of  the  season,  to  classes  far  more  numerous  than 
could  have  been  expected  from  the  short  notice  that  was  given  of  their 
intentions.  In  the  beginning  of  next  winter  all  the  professors  will  assume 
their  functions. 

The  following  are  the  officers  of  the  college: 

President:  Dr.  Brown. 

Secretary:  Dr.  Cocke. 

Treasurer:  Dr.  Birckhead. 

Regents:  Drs.  Birckhead,  Bond,  Brown,  Cocke,  Crawford,  Davidge,  Don- 
aldson, Potter,  Shaw,  of  Baltimore;  Dr.  Warfield,  of  Anne  Arrundel  County: 
Drs.  Anderson,  Johnston,  Martin,  Noel,  Thomas,  of  the  Eastern  Shore. 


EDITORIALS  277 

Medical  Faculty  of  the  College:  Drs.  Davidge  and  Cocke,  Adjunct  Profes- 
sors of  Anatomy,  Phj^siology  and  Surgery;  Dr.  Shaw,  Professor  of  Chemistry; 
Dr.  Bond,  Professor  of  Materia  Medica;  Dr.  Donaldson,  Professor  of  the 
Institues  of  Medicine;  Dr.  Potter,  Professor  of  the  Practise  of  Physick;  and 
Dr.  Davidge,  Dean  of  Faculty. 

The  medical  and  chirurgical  faculty  of  the  state  are  patrons  and  visitors 
of  the  college,  and  their  present  president.  Dr.  Philip  Thomas,  of  Frederick- 
town,  is,  ex  officio,  chancellor  of  the  same. 

Bali.  Med.  and  Phys.  Rec,  No.  1. 

From  Medical  and  Philosophical  Register,  Vol.  V.,  No.  11. 

Contained  in  Medical  Museum,  Vol.  V.  conducted  by  John  Redman  Coxe, 
M.D.,  Philadelphia,  1808. 

Notes  from  the  Mexican  Border 

From  letters  from  Dr.  Nathan  Winslow,  since  July,  1916  in  active 
service  with  the  United  States  Army,  we  learn  that  he  came  out  of 
Mexico  with  General  Pershing's  punitive  expedition  on  February  5, 
1917.  He  made  the  journey  from  Colonia  Dublan  on  horseback, 
a  distance  of  115  miles,  in  extremely  cold  weather  and  consequently 
with  much  discomfort.  He  says,  "the  march  began  at  7.30  a.m., 
we  were  up  before  daylight  and  were  glad  to  lie  down  at  night. 
One  day  on  making  camp  I  lay  down  right  in  the  dirt  and  was  soon 
sound  asleep.  On  another  occasion  my  horse  wanted  to  roll  in  a  soft 
spot  and  before  I  knew  or  realized  what  he  was  up  to  I  was  wallow- 
ing on  the  ground.  The  men  had  a  good  laugh,  so  did  I.  I  feel 
that  the  hike  has  done  me  good  as  I  have  been  working  very  hard 
recently  and  needed  some  such  tonic  as  this  to  brace  me  up.  As 
a  result  of  the  outdoor  exercise  I  feel  a  thousand  per  cent  better." 
From  Columbus,  N.  M.  the  3d  Field  Hospital  was  ordered  to  Fort 
Bliss,  El  Paso,  Texas,  which  trip  was  also  made  on  horseback,  a 
distance  of  105  miles,  and  also  passed  through  a  barren  desert,  where 
it  was  necessary  to  water  the  animals  from  tank  cars  at  definite 
intervals,  about  30  miles  apart.  "The  day  before  we  left  Dublan, 
an  American  boy  was  stabbed,  by  a  Mexican,  in  the  abdomen  and 
the  omentum  protruded  through  the  opening.  The  hospital  had 
been  closed  and  packed  on  wagons  for  24  hours,  ready  for  the  with- 
drawal, but  Capt.  B  and  I  got  together  what  instruments  and  equip- 
ment we  could,  enlarged  the. wound  and  inspected  the  intestine, 
established  drainage  and  sent  him  to  Columbus,  where  he  is  doing 
nicely.  For  this  service  not  a  word  of  thanks  from  the  boy's  father 
who  brought  him  to  the  hospital,  nor  even  an  inquiry  as  to  who 


278  EDITORIALS 

did  the  work.  He  is  a  fair  sample  of  the  American  in  Mexico.  Any- 
thing he  did  for  us  he  would  expect  compensation  for,  but  service 
from  us  he  expects  for  nothing."  Reaching  Fort  Bliss,  Lieutenant 
Winslow  was  detached  from  the  Field  Hospital  and  ordered  to 
Shafter,  Texas,  a  mining  town  in  the  big  bend  region  about  15  miles 
from  the  Rio  Grande.  The  population  of  the  town  is  about  2000, 
of  which  about  100  are  white.  The  rest  are  Mexicans.  Although 
in  an  isolated  region,  he  has  been  fortunate  in  having  the  company 
of  a  former  college  mate.  Dr.  A.  H.  Wliite,  class  of  1902,  who  is 
physician  to  the  smelter  and  mines  located  at  this  place.  Dr. 
Winslow  does  not  think  much  of  the  climate  of  Texas  and  says  he 
would  prefer  to  be  in  Mexico,  owing  to  the  sand  storms  that  are 
common  on  our  side  of  the  border.  He  says,  if  we  are  going  to  have 
a  scrap  with  Germany  he  wants  to  stay  in  the  army  and  see  the 
fun. 

Advisability  of  Continuous  Sessions  of  Medical  Schools 

During  War^ 

The  outbreak  of  war  has  disturbed  very  materially  the  course  of 
affairs  at  the  University  in  all  its  departments.  In  the  medical 
school  there  is  considerable  unrest  and  uncertainty  among  both 
teachers  and  students,  as  to  their  duty  in  the  present  crisis.  At 
the  urgent  request  of  the  Navy  Department  eight  members  of  the 
Senior  Class,  with  combined  averages  of  85  per  cent  for  the  first  three 
years,  have  been  given  practical  and  oral  examinations  bj' a  committee 
of  the  Faculty  and  have  been  excused  from  further  work  for  the 
session,  in  order  that  they  may  be  assigned  at  once  to  duty  in  the 
Navy.  The  Army  requires  that  candidates  for  appointment  as 
medical  officers  shall  have  had  a  year  of  hospital  training  before 
being  permitted  to  take  examination  for  admission  to  the  Army 
Medical  School,  consequentlj^  those  students  who  have  hospital  ap- 
pointments should  keep  their  engagements  as  a  patriotic  duty,  to 
equip  themselves  for  armj^  service  later,  if  needed. 

We  advise  all  old  students  and  prospective  students  to  continue 
their  professional  studies.  The  country  already  is  short  of  doctors, 
notwithstanding  the  statement  of  certain  medical  uplifters  who  say 

1  Since  the  above  was  written  it  has  been  decided  not  to  institute  a  con- 
tinuous session.     The  next  session  will  open  as  usual  on  October  1,  1917. 


EDITORIALS  279 

that  if  every  medical  school  should  be  closed  for  ten  years  there 
would  still  be  a  superfluity  of  physicians,  and  this  shortage  is  bound 
to  increase.  If  this  war  lasts  a  large  number  of  medical  officers 
will  be  required,  and  our  young  men  who  have  begun  the  study  of 
medicine  will  be  able  to  render  a  greater  service  to  the  country  by 
preparing  for  their  work  than  by  entering  the  services  now  or  in  the 
near  future  as  untrained  assistants  or  as  soldiers  in  the  ranks.  Also 
we  recommend  those  who  are  preparing  to  study  medicine,  who  will 
be  qualified  to  enter  the  medical  school  in  October,  to  follow  their 
original  intention,  in  order  that  the  supply  of  physicians  shall  con- 
tinue. Indeed  if  the  selective  draft  is  ordered  it  is  not  likely  that 
prospective  or  actual  medical  students  will  be  taken  for  service 
with  the  troops. 

The  Medical  Board  of  the  Council  of  National  Defense  suggests 
the  advisability  of  continuous  sessions  of  the  medical  schools  for 
the  purpose  of  hastening  the  graduation  of  the  present  third  year 
students.  For  instance  if  the  new  session  should  begin  in  June  or 
July  students  would  be  eligible  to  graduate  in  February  or  March, 
1918.  Before  this  could  be  done  there  would,  however,  have  to  be 
some  action  taken  by  the  various  state  boards  waiving  their  rule  of 
procedure,  in  such  cases. 

Shall  the  University  of  Maryland  adopt  a  continuous  session? 
Of  course  this  depends,  as  stated  above,  on  the  consent  of  the  various 
state  boards  and  also  on  the  wishes  of  our  students.  Although 
both  students  and  teachers  are  tired  and  would  enjoy  a  vacation,  if 
the  demand  is  urgent  the  Faculty,  probabl}^,  would  respond  to  the 
call. 

This  might  require  a  reorganization  of  the  teaching  force,  as  a 
number  of  our  professors  and  teachers  are  also  officers  in  the  National 
Guard  and  in  the  Medical  Reserve  Corps  of  the  Army;  some  of  whom 
are  now  in  active  service.  Our  advice  to  all,  both  students  and 
teachers,  is  to  be  quiet,  don't  become  hysterical,  continue  your  work 
and  respond  to  the  call  of  your  country  in  whatever  way  it  may  come. 


280 


ITEMS 


Recipients  of  Certificates  to  Graduates  of  the  Baltimore 
Medical  College 


Universit}^  of  Maryland  certificates  have  been  issued  to  the  fol- 
lowing graduates  of  the  Baltimore  Medical  College  since  the  edi- 
torial notice  in  our  November  issue  that  called  attention  to  the 
provision  for  obtaining  them. 


1.  Alfred  S.  Horsley,  '91 

2.  D.  H.  R.  Patton,  '96 

3.  C.  B.  Faunce,  Jr.,  '04 

4.  W.  Hampton  Caldwell,  '83 

5.  A.  Morgan  MacWhinnie,  '97 

6.  Walter  E.  Meanwell,  '09 

7.  Edward  T.  Murray,  '98 

8.  George  Herbert  Altree,  '92 

9.  Henry  Clay  Connaway,  '02 

10.  Lawson  A.  Crawford,  '92 

11.  Absalom  A.  Lawton,  '06 

12.  Walter  M.  Dalbey,  '02 

13.  Ambrose  Roche  Ballou,  '05 


14.  James  Alexander  Graham,  '97 

15.  Frank  B.  Cook,  '04 

16.  Francis  J.  Talbot,  '11 

17.  John  B.  Shotwell,  '93 

18.  Louis  Emmitt  Brown,  '02 

19.  Lewis  Mendelsohn,  '01 

20.  Remo  Fabbri,  '09 

21.  James  Robinson  Parker,  '98 

22.  Edward  B.  Evans,  '97 

23.  G.  McHugh,  '98 

24.  Alva  M.  Ashcraft,  '03 

25.  C.  D.  Combs,  '09 

26.  T.  O.  Freeman,  '98 


ITEMS 

Dr.  Alexius  McGlannan  delivered  the  oration  in  Surgery  at  the 
annual  meeting  of  the  Illinois  State  Medical  Society,  held  at 
Bloomington,  May  10,  1917. 

The  graduating  class  of  the  University  Hospital  Training  School 
for  Nurses  were  the  guests  of  the  Nurses'  Alumnae  Association 
at  their  annual  banquet,  held  at  the  Emerson  Hotel  on  May  15, 
at  8  p.m. 

The  following  officers  have  been  elected  by  the  Nurses'  Alumnae 
Association  of  University  Hospital  for  the  ensuing  year:  President, 
Mrs.  Robert  P.  Bay;  First  Vice-President,  Mrs.  Page  Edmunds; 
Second  Vice-President,  Miss  Ellen  C.  Israel;  Secretary,  Mrs.  Frank 
S.  Lynn;  Treasurer,  Mrs.  Nathan  Winslow. 


Miss  Marjorie  B.  Sprecher,  a  graduate  of  the  Nurses'   Training 
School  of  the  University  Hospital,  Class  of  1914,  and  daughter  of 


ITEMS  281 

Dr.  and  Mrs.  Daniel  B.  Sprecher,  of  Sykesville,  Md.,  was  married 
on  April  18,  to  Mr.  John  Woodcock,  of  Hollidaysburg,  Pa. 


The  Medical  Department  of  the  University  of  Maryland  contrib- 
uted to  the  campaign  of  the  Navy  for  recruits  by  graduating  eight 
young  phj^sicians  and  allowing  them  to  go  directly  into  the  United 
States  Navy  Reserve  force  instead  of  making  them  wait  until  June. 

The  eight  men  were  George  Otto  Hartman,  of  Ohio;  Francis  Carl 
Herzog  and  M.  J.  Montgomery,  of  Pennsylvania;  Kenneth  D. 
Legge  and  Herbert  L.  Shinn,  of  Washington;  R.  S.  G.  Welsh,  George 
L.  McClintock  and  George  L.  White,  of  Maryland.  Welsh  was  a 
foot  ball  star  of  St.  John's  College  and  was  pronounced  by  Medical 
Director  Stitt,  of  the  United  States  Navy,  the  most  splendid  speci- 
men of  physical  development  he  had  examined. 

Receiving  his  diploma  from  the  University  of  MarjdancI,  getting 
married  and  joining  the  Navy  kept  Dr.  George  O.  Hartman,  an  in- 
terne at  the  Franklin  Square  Hospital,  busy  last  week. 

Dr.  Hartman  was  one  of  the  lucky  men  with  an  average  over  85 
per  cent  who  were  graduated  last  week.  Wednesday  he  passed  the 
physical  test  for  the  Navy  and  received  the  commission  of  junior 
lieutenant.  Saturday  his  war  bride.  Miss  Grace  A.  Radabaugh, 
came  to  this  city  from  his  home  town,  Toledo,  Ohio,  and  they  were 
married  yesterday.     He  will  report  for  duty  tomorrow. 


Dr.  Fitz  Randolph  Winslow,  '06,  of  Baraboo,  Wis.,  recently 
visited  the  Mayo  Clinic  at  Rochester,  Minn.,  where  he  was  the  re- 
cipient of  much  attention  from  the  group  of  University  of  Maryland 
men  who  are  students  on  the  Mayo  Foundation.  He  says  they  are 
a  fine  lot  of  fellows  who  are  doing  excellent  work. 


Mr.  William  J.  A.  Conner  announces  the  marriage  of  his  sister 
Miss  Emily  Ruth  Conner  to  Dr.  Charles  Reid  Edwards,  on  Satur- 
day afternoon,  the  twenty-eighth  of  April,  at  half  after  four  o'clock, 
Strawbridge  M.  E.  Church,  Baltimore,  Maryland. 

Miss  Conner  graduated  from  the  University  of  Maryland  train- 
ing school  class  of  1915. 


282  ITEMS 

The  familj^  of  Henry  Newcomer,  Benevola,  handed  a  $1000  check 
to  the  Rev.  C.  M.  Sparrow,  pastor  of  Benevola  United  Brethren 
Church,  to  be  appHed  to  the  fund  for  the  erection  of  a  new  church 
edifice.  The  check  was  given  as  a  memorial  to  Henry  Newcomer's 
son,  the  'ate  Dr.  E'mer  Newcomer,  superintendent  of  the  IMary- 
land  General  Hospital,  Baltimore. 


The  annual  meeting  of  aUenists  and  neurologists  will  be  held 
Monday,  July  9  to  Thursday  July  12,  1917,  in  the  Red  Room, 
LaSalle  Hotel,  Chicago,  under  the  auspices  of  the  Chicago  Medical 
Society.  Dr.  George  A.  Zeller  will  act  as  Chairman.  The  program 
will  be  mailed  June  28,  with  abstract  of  each  paper.  Contributors 
to  the  program  are  solicited.  This  is  a  society  without  a  member- 
ship fee. 

Address,  Secretary  A.  &  N.,  Room  1218-30  N.  Michigan  Avenue, 
Chicago. 

Dr.  O.  H.  Bobbitt,  P.  &  S.  1914,  located  at  Widen,  W.  Va.,  is 
visiting  the  College  and  Mercy  Hospital. 

Dr.  A.  M.  Burt,  P.  &  S.  1904,  Mannington,  W.  Va.,  recently 
visited  the  College. 

Dr.  F.  J.  Cummings,  P.  &  S.  1903,  located  at  Ticonderoga,  N. 
Y.,  visited  the  College  and  Mercy  Hospital  recently. 


Dr.  Fred  Rankin,  now  at  Rochester,  Minn.,  expects  to  go  to 
France  with  the  University  of  Minnesota  unit.  He  is  one  of  three 
surgeons  from  the  Mayo  Clinic  to  accompany  this  unit. 


Mrs.  Walter  L.  Bogert  announces  the  marriage  of  her  daughter, 
Corinne  Loraine  and  Mr.  William  Ellsworth  Starford,  on  Thursday, 
the  twenty-sixth  day  of  April,  nineteen  hundred  and  seventeen, 
"Rockdale,"  Martinsburg,  West  Virginia. 

Miss  Bogert  graduated  from  the  University  Hospital  Training 
School  in  the  class  of  1915. 


ITEMS  283 

The  Medical  Society  of  the  University  of  Maryland,  School  of 
Medicine  and  College  of  Physicians  and  Surgeons,  was  held  in 
Chemical  Hall  at  University,  on  March  21,  1917. 

The  special  attraction  was  a  most  interesting  address  on  "Birth 
injuries  of  the  shoulder,"  illustrated  with  numerous  lantern  slides, 
by  Dr.  Astley  P.  C.  Ashhurst,  of  Philadelphia.  This  was  a  com- 
paratively new  subject  to  us  and  consequently  was  very  instructive. 

Dr.  Randolph  Winslow  also  made  remarks  on  "Cystic  Hygroma 
of  the  neck  and  shoulder,"  with  lantern  slides  illustrating  the 
condition. 

Dr.  Albert  H.  Carroll,  who  has  just  completed  his  third  term  as 
president  of  the  society,  presided  and  announced  that  he  would  not 
be  a  candidate  for  reelection.  Dr.  Carroll's  services  as  president 
have  been  of  great  value  and  it  will  be  difficult  to  secure  another 
presiding  officer  of  equal  efficiency. 

On  invitation  of  the  staff,  the  Baltimore  County  Medical  Asso- 
ciation held  a  largely  attended  meeting  at  the  University  Hospital, 
on  March  21,  1917,  at  2  p.m.  Mr.  H.  H.  Warfield,  manager  of  the 
hospital  served  an  excellent  luncheon  previous  to  the  scientific 
session,  to  which  ample  justice  was  done.  Adjourning  to  the  Clini- 
cal amphitheatre  short  talks  were  made  by  Dr.  Randolph  Winslow, 
on  the  treatment  of  fractures  of  the  neck  of  the  humerus  and  the 
neck  of  the  femur;  by  Dr.  Frank  Martin  on  the  advantages  of 
cholecystectomy  over  cholecystotomy;  by  Dr.  Hiram  Woods  on 
the  medical  aspects  of  eye  diseases;  by  Dr.  L.  Ernest  Neale  on 
inversion  of  the  uterus,  due  to  traction  on  the  umbilical  cord;  by 
Dr.  J.  Mason  Hundley  on  the  diagnosis  of  renal  calculus;  and  by 
Dr.  Gordon  Wilson  on  acute  tuberculosis  simulating  typhoid  fever. 
Dr.  J.  W.  Holland  exhibited  some  interesting  specimens  with  chni- 
cal  histories  and  Dr.  Howard  J.  Maldies  gave  a  beautiful  demon- 
stration of  pathological  specimens  in  the  pathological  laboratory. 
Dr.  Wm.  J.  Todd  of  Mt.  Washington  presented  an  interesting 
volume  of  reprints  to  the  library  of  the  university.  We  feel  that 
such  meetings  are  of  great  value  to  both  the  county  members  and 
ourselves  and  we  hope  they  will  be  more  frequent  in  the  future  than 
they  have  been  in  the  past. 

H.  B.  Maxwell,  M.D.,  U.  of  M,  1902,  of  Whiteville,  N.  C,  re- 
cently visited  the  University. 


284  ITEMS 

The  regulaT  monthly  meeting  of  the  Mercy  Hospital  House  Staff 
Medical  Society  was  held  at  the  Hospital  on  Wednesday  evening 
March  28.  Papers  were  read  by  Drs.  Mayer,  McKenzie  and  Chaput 
which  were  discussed  by  other  members  of  the  House  Staff. 

The  following  publication  from  the  department  of  physiology  of 
the  University  of  Maryland  is  announced:  Experimental  and  his- 
torical researches,  published  from  the  laboratory  of  physiology  of  the 
University  of  Maryland,  by  John  C.  Hemmeter,  Phil.D.,  M.D., 
Sc.D.,  LL.D.,  fellow  of  the  American  Association  for  the  Advance- 
ment of  Science,  member  of  the  Physiological  Society  of  Germany, 
member  of  the  German  Congress  for  Internal  Medicine,  F.  R.  S. 
A.,  England,  member  of  the  Imperial  German  Academy  of  Nat- 
ural Sciences  (Kaiserl.  Carolin.-Leopold.  Akad.  d.  Naturforscher.)-, 
member  of  the  Imperial  Association  of  Austrian  Physicians  (Vienna), 
etc.,  professor  of  physiology  and  director  of  the  Physiologcial  Lab- 
oratory in  the  University  of  Maryland,  etc.;  also  by  Thomas  L. 
Patterson,  M.S.,  M.Sc,  associate  professor  of  physiology  and 
biology.  University  of  Maryland,  fellow  of  the  Royal  Society  of 
Arts  (London),  fellow  of  the  Royal  Meteorological  Society  (Lon- 
don), member  of  the  American  Association  for  the  Advancement  of 
Science,  member  of  the  American  Genetic  Association,  etc.,  1917. 

Dr.  H.  M.  Robinson,  U.  M.  '09,  announces  the  opening  of  an 
office  at  405  North  Charles  Street.  Hours:  10  to  12  and  by  ap- 
pointment.    Mt.  Vernon  5564. 

Jas.  A.  Duggan,  U.  of  M.  1912,  recently  in  charge  of  a  tubercu- 
losis sanitarium  at  South  Bend,  Ind.,  has  been  appointed  assistant 
surgeon  in  the  Navy. 

Dr.  Jos.  Lipskey,  P.  &  S.  1914,  who  has  been  practicing  in 
Fleming,  Ky.,  for  the  past  two  years,  is  visiting  in  Baltimcre, 


ITEMS  285 

The  Commencement  of  the  Mercy  Hospital  Training  School  for 
Nurses  was  held  on  May  15,  1917.  The  address  to  the  graduates 
was  given  by  Dr.  Andrew  C.  Gillis.  The  diplomas  were  conferred 
by  Dean  J.  M.  H.  Rowland. 

The  graduates  were:  Sister  M.  Hilda  Bushman,  Maryland; 
Sister  M.  Hildegard  Holbein,  Maryland;  Sister  M.  Aloysius  Kava- 
nagh,  Georgia;  Beulah  Dohl  Atkins,  Virginia;  Eloise  Biser,  Mary- 
land; Mary  Burke,  Pennsylvania;  Anna  Belle  Burns,  West  Virginia; 
Mary  Estelle  Carver, "  Maryland;  Mary  Caroline  Christy,  West 
Virginia;  Marjorie  Alricks  Duncan,  Maryland;  Mae  Agnes  Fannin, 
Virginia;  Helen  Edna  Harbour,  West  Virginia;  Mary  Adelia  Kelly, 
Maryland;  Adla  Marie  Mansur,  Syria;  Madeline  de  Sales  Roche, 
Pennsylvania;  Anne  Rosalia  Sappington,  Maryland;  Edna  Frances 
Sappington,  Maryland;  Aurele  Beatrice  Vogel,  Pennsylvania; 
Mary  Ruth  Worthington,  Maryland. 

The  Twenty-fifth  Annual  Commencement  of  the  University 
Hospital  Training  School  for  Nurses  was  held  on  the  evening  of 
May  17,  1917,  at  Lehman's  Hall  in  the  presence  of  a  large  and 
appreciative  audience.  Addresses  were  made  by  Provost  Thomas 
Fell  and  Dr.  Arthur  M.  Shipley. 

The  following  is  the  list  of  the  graduates:  Adeline  Bell  Cavano, 
Maryland;  Jane  Adaline  Pennewcll,  Maryland;  Myrtle  May  Fahr- 
ney,  Maryland;  Elizabeth  Louisa  Marsh,  Marjdand;  Bertha  May 
Quigley,  Maryland;  Marguerite  Eugenia  Rislej^,  Maryland;  Lucy 
Edith  Mouse,  Maryland;  Laura  Augusta  Keefer,  Virginia;  Lillie 
Seaton  Hedges,  Maryland;  Anna  Carlyle  Robinson,  New  Jersey; 
Nancy  Josephine  Klase,  Virginia;  Jemima  Minnis,  Pennsylvania; 
Nancy  Minms,  Pennsylvania;  Catherine  Ethel  Monroe,  Maryland; 
Emily  Elizabeth  Kenney,  Delaware;  Annette  Purcelle  Stoneham, 
Virginia;  Ellen  Christene  Lloyd,  Maryland;  Elsie  Mae  Simpson, 
Maryland;  Helen  Louise  Dearmycr,  Michigan;  Rhetta  Catherine 
Shertzer,  Pennsylvania;  Norma  Augusta  Thorn,  New  Jersey;  Anna 
Roeder  Mohler,  District  of  Columbia ;  Olive  Ellen  Murray,  Maryland ; 
Leanora  Andrews  Cecil,  Maryland. 

The  graduation  exercises  of  nurses  of  the  Maryland  General 
Hospital  who  completed  their  training  this  year  was  held  at  First 
Methodist  Episcopal  Church,  St.  Paul  and  Twenty-second  streets. 

Those  who  received  diplomas  are  Misses  Mildred  E.  Hoover, 
Wilhelmina   Haubert,    Sue    Robinson.     Louise    Catherine    Lender- 


286  DEATHS 

king,  Martha  M.  Bendall,  Margaret  Ida  Collison,  Myrtle  Jenkins, 
Edna  Lee  Morris,  Anna  Katharine  Klein,  Mary  Katharine  Bangert, 
Mildred  Vincent  Ashley  and  Elsie  Reece  Clark. 

DEATHS 

Dr.  A.  B.  Van  Valzah,  P.  &  S.  1885,  died  of  Brights  disease  at 
Springfield,  Oregon,  September  5,  1916.  This  late  account  is  due 
to  the  fact  that  we  have  just  heard  of  his  death  through  his  wife, 
who  at  the  same  time  made  a  contribution  to  the  Chamber's  Memo- 
rial Fund  in  memory  of  her  husband. 

Dr.  J.  Edward  Hoole,  P.  &  S.  1903,  died  of  angina  pectoris  at 
West  Somerville,  Massachusetts,  on  February  15,  1917.  Accord- 
ing to  accounts  Dr.  Hoole  had  contemplated  a  visit  to  Baltimore, 
when  he  was  stricken. 

Dr.  Dayton  J.  Long,  P.  &  S.  '97,  of  Piedmont,  W.  Va.,  died  April 
5,  1917,  from  injuries  following  an  automobile  accident.  Dr.  Long 
was  resident  obstetrician  at  the  Maryland  Lying-In-Hospital 
1897-98. 

Robt.  Vernon  Palmer,  C.  P.  &  S,  1894,  of  Livingston  Heights,  Va., 
is  said  to  have  committed  suicide  on  April  5  by  hanging  himself  to 
the  bed  post  by  a  rope  made  of  towels;  aged  52. 

Irving  J.  Sampson,  B.  M.  C.  1898,  of  Mellette,  S.  D.,  while  mak- 
ing a  professional  call  at  night,  on  March  31,  was  drowned  while 
attempting  to  ford  a  creek;  aged  45. 

Jas.  E.  Clawson,  U.  of  M.  1855,  died  at  his  home  in  Philadelphia 
on  April  13;  aged  88. 

Lemuel  M.  Line,  C.  P.  &  S.  1884,  of  Columbus,  Mont.,  died  at 
his  home  on  april  6;  aged  55. 

Wilbert  F.  Sadler,  C.  P.  &  S.,  1881,  of  Montgomery,  Ala.,  died 
at  his  home  on  March  26;  aged  69. 


J!i*. 


V-  -: